1: 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, Massachusetts, USA.
OBJECTIVES: The US Advisory Committee on Immunization Practices has recently
recommended a new vaccine against herpes zoster (shingles) for routine use in
adults aged >/=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 >/=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 - in process]
2: 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
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 - in process]
3: 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.
Publication Types:
Review
PMID: 18243932 [PubMed - indexed for MEDLINE]
4: Drug Ther Bull. 2008 Feb;46(2):14-6.
Lidocaine plasters for postherpetic neuralgia?
[No authors listed]
Each year in the UK, about 1 in 2,500 people experiences neuropathic pain that is
still present 3-6 months after acute herpes zoster (shingles).1 This condition,
known as postherpetic neuralgia, is the most common complication of herpes zoster
and can be chronic, intractable and distressing. Treatments used in an attempt to
reduce postherpetic neuralgia include tricyclic antidepressants (e.g.
amitriptyline - an unlicensed indication), antiepileptics (e.g. gabapentin) and
opioid analgesics, as well as topical treatments such as capsaicin.2 However,
such treatments may only provide partial pain relief, and tolerability can be a
problem, particularly in older patients.2 Versatis (Grunenthal Ltd), a topical
preparation of lidocaine formulated in a plaster, has recently been licensed for
treating patients with postherpetic neuralgia.3 Does it offer useful benefit?
PMID: 18256177 [PubMed - in process]
5: 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]
6: Mayo Clin Health Lett. 2007 Oct;25(10):4.
Vaccine cuts by half the risk of developing shingles.
[No authors listed]
Publication Types:
News
PMID: 18229411 [PubMed - indexed for MEDLINE]
7: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 18166463 [PubMed - in process]
8: 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.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 18166461 [PubMed - in process]
9: 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.
medica, medizinische Laboratorien Dr. F. Kaeppeli, ZГјrich, 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 - in process]
10: J Virol Methods. 2008 Jan 19 [Epub ahead of print]
A highly efficient protocol of generating and analyzing VZV ORF deletion mutants
based on a newly developed luciferase VZV BAC system.
Zhang Z, Huang Y, Zhu H.
Department of Microbiology and Molecular Genetics, UMDNJ-New Jersey Medical
School, 225 Warren Street, Newark, NJ 07101, United States.
Varicella Zoster Virus (VZV) is the causative agent for both varicella (chicken
pox) and herpes zoster (shingles). As a member of the human herpesvirus family,
VZV contains a large DNA genome, encoding 70 unique open reading frames (ORFs).
The functions of the majority of these ORFs remain unknown. Recently, the
full-length VZV (P-Oka strain) genome was cloned as a VZV bacteria artificial
chromosome (BAC) and additionally a firefly luciferase cassette was inserted to
generate a novel luciferase VZV BAC. In this study, a highly efficient protocol
has been developed exploiting the new luciferase VZV BAC system to rapidly
isolate and characterize VZV ORF deletion mutants by growth curve analysis in
cell culture.
PMID: 18215429 [PubMed - as supplied by publisher]
11: 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.
Publication Types:
Review
PMID: 18195672 [PubMed - indexed for MEDLINE]
12: J Ark Med Soc. 2007 Dec;104(6):139.
An unusual case of shingles.
Dildy DW Jr, McLeane LR.
Publication Types:
Case Reports
PMID: 18092499 [PubMed - indexed for MEDLINE]
13: 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.
Publication Types:
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 18021866 [PubMed - indexed for MEDLINE]
14: 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 - in process]
15: 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 - in process]
16: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 17997705 [PubMed - indexed for MEDLINE]
17: Waste Manag. 2007 Oct 31 [Epub ahead of print]
Measuring the gypsum content of C&D debris fines.
Musson SE, Xu Q, Townsend TG.
Department of Environmental Engineering Sciences, University of Florida,
Gainesville, FL 32611-6450, USA.
Construction and demolition (C&D) debris recycling facilities often produce a
screened material intended for use as alternative daily cover (ADC) at active
landfills or for shaping and grading at closed landfills. This product contains
soil and small pieces of wood, concrete, gypsum drywall, shingles and other
components of C&D debris. Concerns have been raised over the contribution of
gypsum drywall in C&D debris fines to odor problems at landfills where the
product is used. To address such concerns, limitations may be placed on the
percentage of gypsum (or sulfate) that can occur, and standardized testing
procedures are required to permit valid compliance testing. A test procedure was
developed for measuring the gypsum content in C&D debris fines. The concentration
of sulfate leached in an aqueous solution was used to estimate the initial gypsum
content of the sample. The impact of sample size and leaching time were
evaluated. Precision and accuracy increased with increasing gypsum content.
Results from replicate samples had an average relative standard deviation of 9%.
The gypsum content of fines obtained from different facilities in the US varied
widely from 1% to over 25%. These variations not only occurred between differing
facilities, but within batches produced within a single facility.
PMID: 17980573 [PubMed - as supplied by publisher]
18: J Antimicrob Chemother. 2007 Dec;60(6):1316-30. Epub 2007 Oct 22.
Preclinical development of bicyclic nucleoside analogues as potent and selective
inhibitors of varicella zoster virus.
McGuigan C, Pathirana RN, Migliore M, Adak R, Luoni G, Jones AT, DГez-Torrubia A,
Camarasa MJ, VelГЎzquez S, Henson G, Verbeken E, Sienaert R, Naesens L, Snoeck R,
Andrei G, Balzarini J.
Welsh School of Pharmacy, Cardiff University, King Edward VII Avenue, Cardiff
CF10 3XF, UK. mcguigan@cardiff.ac.uk
OBJECTIVES: To progress the anti-varicella-zoster-virus (VZV) aryl bicyclic
nucleoside analogues (BCNAs) to the point of Phase 1 clinical trial for herpes
zoster. METHODS: A new chromatography-free synthetic access to the lead anti-VZV
aryl BCNAs is reported. The anti-VZV activity of lead Cf1743 was evaluated in
monolayer cell cultures and organotypic epithelial raft cultures of primary human
keratinocytes. Oral dosing in rodents and preliminary pharmacokinetics assessment
was made, followed by an exploration of alternative formulations and the
preparation of pro-drugs. We also studied uptake into cells of both parent drug
and pro-drug using fluorescent microscopy and biological assays. RESULTS: Cf1743
proved to be significantly more potent than all reference anti-VZV compounds as
measured either by inhibition of infectious virus particles and/or by viral DNA
load. However, the very low water solubility of this compound gave poor oral
bioavailability (approximately 14%). A Captisol admixture and the
5'-monophosphate pro-drug of Cf1743 greatly boosted water solubility but did not
significantly improve oral bioavailability. The most promising pro-drug to emerge
was the HCl salt of the 5'-valyl ester, designated as FV-100. Its uptake into
cells studied using fluorescent microscopy and biological assays indicated that
the compound is taken up by the cells after a short period of incubation and
limited exposure to drug in vivo may have beneficial effects. CONCLUSIONS: On the
basis of its favourable antiviral and pharmacokinetic properties, FV-100 is now
being pursued as the clinical BCNA candidate for the treatment of VZV shingles.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17956908 [PubMed - in process]
19: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 17945155 [PubMed - indexed for MEDLINE]
20: 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
Publication Types:
Case Reports
PMID: 17920919 [PubMed - indexed for MEDLINE]
21: J Virol. 2007 Dec;81(23):13200-8. Epub 2007 Oct 3.
A self-excisable infectious bacterial artificial chromosome clone of
varicella-zoster virus allows analysis of the essential tegument protein encoded
by ORF9.
Tischer BK, Kaufer BB, Sommer M, Wussow F, Arvin AM, Osterrieder N.
Department of Microbiology and Immunology, College of Veterinary Medicine,
Cornell University, Ithaca, NY 14853, USA.
In order to facilitate the generation of mutant viruses of varicella-zoster virus
(VZV), the agent causing varicella (chicken pox) and herpes zoster (shingles), we
generated a full-length infectious bacterial artificial chromosome (BAC) clone of
the P-Oka strain. First, mini-F sequences were inserted into a preexisting VZV
cosmid, and the SuperCos replicon was removed. Subsequently, mini-F-containing
recombinant virus was generated from overlapping cosmid clones, and full-length
VZV DNA recovered from the recombinant virus was established in Escherichia coli
as an infectious BAC. An inverted duplication of VZV genomic sequences within the
mini-F replicon resulted in markerless excision of vector sequences upon virus
reconstitution in eukaryotic cells. Using the novel tool, the role in VZV
replication of the major tegument protein encoded by ORF9 was investigated. A
markerless point mutation introduced in the start codon by two-step en passant
Red mutagenesis abrogated ORF9 expression and resulted in a dramatic growth
defect that was not observed in a revertant virus. The essential nature of ORF9
for VZV replication was ultimately confirmed by restoration of the growth of the
ORF9-deficient mutant virus using trans-complementation via baculovirus-mediated
gene transfer.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 17913822 [PubMed - indexed for MEDLINE]
22: Evid Based Dent. 2007;8(3):85-6.
Comment on:
Cochrane Database Syst Rev. 2007;(2):CD004846.
Insufficient evidence to recommend topical lidocaine as first-line treatment for
postherpetic neuralgia.
Zakrzewska JM.
Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital,
University College London NHS Foundation Trust, London, UK.
DATA SOURCES: The Cochrane Pain, Palliative and Supportive Care Group Trials
Register, Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS
(Latin American and Caribbean Health Sciences), SIGLE (System for Information on
Grey Literature in Europe)(for conference proceedings) and Science Citation Index
were searched, along with the reference lists of all eligible trials, key
textbooks and previous systematic reviews. Authors of all identified trials were
contacted. STUDY SELECTION: Studies of interest were randomised controlled trials
(RCT) or quasi-RCT comparing all topical applications of lidocaine, including
gels and patches in people of all ages suffering from postherpetic neuralgia
(PHN; pain persisting at the site of shingles at least 1 month after the onset of
the acute rash). DATA EXTRACTION AND SYNTHESIS: Data were extracted independently
by two authors with disputes resolved by a third reviewer. A meta-analysis was
conducted using a fixed-effect approach. RESULTS: Three trials were included,
giving a total of 182 individuals who used topical lidocaine and 132 controls.
Two trials provided data on pain relief, and the remaining study provided data on
secondary outcome measures. The largest trial published as an abstract compared a
topical lidocaine patch to a placebo patch and accounted for 150 of the 314
patients (48%). A meta-analysis combining two of the three studies identified a
significant difference between the topical lidocaine and control groups for the
primary outcome measure: a mean improvement in pain relief according to a pain
relief scale. Topical lidocaine relieved pain better than placebo (P 0.003).
There was a statistical difference between the groups for the secondary outcome
measure of mean score-reduction on a visual analogue scale (P 0.030), but this
was only for a single small trial. There were a similar number of adverse skin
reactions in both treatment and placebo groups. CONCLUSIONS: There is
insufficient evidence to recommend topical lidocaine as a first-line agent in the
treatment of PHN with allodynia. Further research should be undertaken on the
efficacy of topical lidocaine for other chronic neuropathic pain disorders, and
also to compare different classes of drugs (eg, topical anaesthetics versus
anti-epileptics).
Publication Types:
Comment
PMID: 17891129 [PubMed]
23: 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]
24: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17855575 [PubMed - indexed for MEDLINE]
25: Clin Ther. 2007 Jul;29(7):1491-507.
Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for
postherpetic neuralgia in the United Kingdom.
Dakin H, Nuijten M, Liedgens H, Nautrup BP.
Abacus International, Bicester, Oxfordshire, United Kingdom.
helen.dakin@abacusint.com
BACKGROUND: Approximately 50% of elderly patients develop postherpetic neuralgia
(PHN) after herpes zoster infection (shingles). A lidocaine 5% medicated plaster
marketed in the United Kingdom in January 2007 has been shown to be an effective
topical treatment for PHN with minimal risk of systemic adverse effects.
OBJECTIVE: This paper assessed the cost-effectiveness of using a lidocaine
plaster in place of gabapentin in English primary care practice to treat those
PHN patients who had insufficient pain relief with standard analgesics and could
not tolerate or had contraindications to tricyclic antidepressants (TCAs). The
analysis took the perspective of the National Health Service (NHS). METHODS: The
costs and benefits of gabapentin and the lidocaine plaster were calculated over a
6-month time horizon using a Markov model. The model structure allowed for
differences in costs, utilities, and transition probabilities between the initial
30-day run-in period and maintenance therapy and also accounted for add-in
medications and drugs received by patients who discontinued therapy. Most
transition probabilities were based on non-head-to-head clinical trials
identified through a systematic review. Data on resource utilization,
discontinuation rates, and add-in or switch medications were obtained from a
Delphi panel; cost data were from official price tariffs. Published utilities
were adjusted for age and were supplemented and validated by the Delphi panel.
RESULTS: Six months of therapy with the lidocaine plaster cost pound 549 per
patient, compared with pound 718 for gabapentin, and generated 0.05 more
quality-adjusted life-years (QALYs). The lidocaine plaster therefore dominated
gabapentin (95% CI, dominant- pound 2163/QALY gained). Probabilistic sensitivity
analysis showed that there was a 90.15% chance that the lidocaine plaster was
both less costly and more effective than gabapentin and a 99.99% chance that it
cost < pound 20,000/QALY relative to gabapentin. Extensive deterministic
sensitivity analyses confirmed the robustness of the conclusions. CONCLUSION:
This study found that the lidocaine 5% medicated plaster was a cost-effective
alternative to gabapentin for PHN patients who were intolerant to TCAs and in
whom analgesics were ineffective, from the perspective of the NHS.
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 17825701 [PubMed - indexed for MEDLINE]
26: Vaccine. 2007 Oct 10;25(41):7087-93. Epub 2007 Aug 15.
Phenotypic and functional characterization of ex vivo T cell responses to the
live attenuated herpes zoster vaccine.
Patterson-Bartlett J, Levin MJ, Lang N, Schödel FP, Vessey R, Weinberg A.
Department of Pediatrics of the University of Colorado School of Medicine,
Denver, CO 80262, USA.
To define the phenotypic characteristics and kinetics of T cell responses to a
shingles vaccine in elderly individuals, 20 subjects > or =60 years of age
received two doses of vaccine or placebo 6 weeks apart. VZV-specific T cell
phenotypes and intracellular cytokines were determined by flow cytometry on blood
mononuclear cells obtained pre-vaccination and up to 6 months after the second
immunization. Results were compared with responses of five unvaccinated young
adults. Pre-vaccination, elderly individuals had significantly lower VZV-specific
effectors and cytokine-producing T cells compared with young adults. The vaccine
significantly increased VZV-specific Th1, memory, early effector, and cutaneous
homing receptor-bearing T cells.
Publication Types:
Comparative Study
Research Support, N.I.H., Extramural
PMID: 17766015 [PubMed - indexed for MEDLINE]
27: 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]
28: JAAPA. 2007 Jul;20(7):56.
Patient information. Should I get the shingles vaccine?
[No authors listed]
PMID: 17695100 [PubMed - indexed for MEDLINE]
29: 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]
30: 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]
31: Cleve Clin J Med. 2007 Jul;74(7):489-94, 496, 498-9 passim.
Comment in:
Cleve Clin J Med. 2007 Jul;74(7):472.
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.
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.
Publication Types:
Research Support, N.I.H., Extramural
Review
PMID: 17682626 [PubMed - indexed for MEDLINE]
32: 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.
Publication Types:
Review
PMID: 17624059 [PubMed - indexed for MEDLINE]
33: J Ethnobiol Ethnomed. 2007 Jul 10;3:29.
Use of traditional medicines in the management of HIV/AIDS opportunistic
infections in Tanzania: a case in the Bukoba rural district.
Kisangau DP, Lyaruu HV, Hosea KM, Joseph CC.
Department of Botany, University of Dar es Salaam, Dar es Salaam, Tanzania.
kisangau@yahoo.com
BACKGROUND: Ethnobotanical surveys were carried out to document herbal remedies
used in the management of HIV/AIDS opportunistic infections in Bukoba Rural
district, Tanzania. The district is currently an epicenter of HIV/AIDS and
although over 90% of the population in the district relies on traditional
medicines to manage the disease, this knowledge is impressionistic and not well
documented. The HIV/AIDS opportunistic conditions considered during the study
were Tuberculosis (TB), Herpes zoster (Shingles), Herpes simplex (Genital
herpes), Oral candidiasis and Cryptococcal meningitis. Other symptomatic but
undefined conditions considered were skin rashes and chronic diarrhea. METHODS:
An open-ended semi-structured questionnaire was used in collecting field
information. Descriptive statistics were used to analyze the ethnobotanical data
collected. Factor of informant consensus (Fic) was used to analyze the
ethnobotanical importance of the plants. RESULTS: In the present study, 75 plant
species belonging to 66 genera and 41 families were found to be used to treat one
or more HIV/AIDS related infections in the district. The study revealed that TB
and oral candidiasis were the most common manifestations of HIV/AIDS
opportunistic infections affecting most of the population in the area. It unveils
the first detailed account of ethnomedical documentation of plants focusing the
management of HIV/AIDS related infections in the district. CONCLUSION: It is
concluded that the ethnopharmacological information reported forms a basis for
further research to identify and isolate bioactive constituents that can be
developed to drugs for the management of the HIV/AIDS opportunistic infections.
Publication Types:
Multicenter Study
Research Support, Non-U.S. Gov't
PMID: 17623081 [PubMed - indexed for MEDLINE]
34: Nursing. 2007 Jul;37(7):29.
Myths and facts...about shingles.
Quillen TF.
PMID: 17603352 [PubMed - indexed for MEDLINE]
35: 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.
Publication Types:
Review
PMID: 17594207 [PubMed - indexed for MEDLINE]
36: 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]
37: Community Pract. 2007 May;80(5):9.
Shingles.
Wyndham M.
PMID: 17536461 [PubMed - indexed for MEDLINE]
38: 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.
Publication Types:
Clinical Trial
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 17511925 [PubMed - indexed for MEDLINE]
39: 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.
Publication Types:
Review
PMID: 17488884 [PubMed - indexed for MEDLINE]
40: 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.
Publication Types:
Review
PMID: 17488883 [PubMed - indexed for MEDLINE]
41: Nat Biotechnol. 2007 Jun;25(6):663-8. Epub 2007 May 7.
Comment in:
Nat Biotechnol. 2007 Jun;25(6):645-6.
Genome-scale analysis of in vivo spatiotemporal promoter activity in
Caenorhabditis elegans.
Dupuy D, Bertin N, Hidalgo CA, Venkatesan K, Tu D, Lee D, Rosenberg J, Svrzikapa
N, Blanc A, Carnec A, Carvunis AR, Pulak R, Shingles J, Reece-Hoyes J,
Hunt-Newbury R, Viveiros R, Mohler WA, Tasan M, Roth FP, Le Peuch C, Hope IA,
Johnsen R, Moerman DG, BarabГЎsi AL, Baillie D, Vidal M.
Center for Cancer Systems Biology, Department of Cancer Biology, Dana-Farber
Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA.
Differential regulation of gene expression is essential for cell fate
specification in metazoans. Characterizing the transcriptional activity of gene
promoters, in time and in space, is therefore a critical step toward
understanding complex biological systems. Here we present an in vivo
spatiotemporal analysis for approximately 900 predicted C. elegans promoters
(approximately 5% of the predicted protein-coding genes), each driving the
expression of green fluorescent protein (GFP). Using a flow-cytometer adapted for
nematode profiling, we generated 'chronograms', two-dimensional representations
of fluorescence intensity along the body axis and throughout development from
early larvae to adults. Automated comparison and clustering of the obtained in
vivo expression patterns show that genes coexpressed in space and time tend to
belong to common functional categories. Moreover, integration of this data set
with C. elegans protein-protein interactome data sets enables prediction of
anatomical and temporal interaction territories between protein partners.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 17486083 [PubMed - indexed for MEDLINE]
42: Am J Prev Med. 2007 May;32(5):370-4.
Preventive misconception: its nature, presence, and ethical implications for
research.
Simon AE, Wu AW, Lavori PW, Sugarman J.
National Center for Health Statistics, Centers for Disease Control and
Prevention, Hyattsville, Maryland, USA.
BACKGROUND: Ethical aspects of prevention trials, as they differ from therapeutic
trials, have not been fully explored. This article aims to define and demonstrate
the existence of "preventive misconception" (PM), a misunderstanding in which
research participants in prevention trials make an "overestimate in probability
or level of personal protection that is afforded by being enrolled in a trial of
a preventive intervention." METHODS: A rating tool was developed to evaluate PM,
using data collected between August 2000 and July 2002 as part of a nationwide
study of the quality of informed consent in a trial of a shingles vaccine. During
2005-2006, two pair of raters assessed the responses of 50 participants to
questions asked after the participants had given consent to participate in the
shingles trial. Two pair of raters evaluated the response for the presence and
type of PM. Each pair of raters adjudicated their responses and inter-rater
reliability was assessed. RESULTS: Adjudicated pairs of raters agreed that 32%
(CI: 20.7%-45.9%) of participants showed evidence of PM (kappa=0.71, CI:
0.52-0.90); that 12% (CI: 5.2%-24.2%) of participants underestimated the
probability of receiving placebo (kappa=0.53, CI: 0.24-0.83); and that 24% (CI:
14.2%-37.6%) overestimated the likely personal effectiveness of the experimental
intervention (kappa=0.42, CI: 0.08-0.76). CONCLUSIONS: This study newly describes
the concept of preventive misconception and empirically demonstrates its
existence in trials of prevention. Study participants may overestimate the
protection that they receive by being enrolled in a trial of prevention, which
poses ethical challenges for research.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17478261 [PubMed - indexed for MEDLINE]
43: Inflamm Bowel Dis. 2007 Sep;13(9):1178-9.
Comment on:
Clin Gastroenterol Hepatol. 2006 Dec;4(12):1483-90.
Nailing down the shingles in IBD.
Kotton CN.
Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit Street Cox
5, Boston, MA 02114, USA.
Publication Types:
Comment
PMID: 17476676 [PubMed]
44: Philos Trans R Soc Lond B Biol Sci. 2007 Nov 29;362(1487):2105-21.
Hypoxia and the antipredator behaviours of fishes.
Domenici P, Lefrançois C, Shingles A.
CNR-IAMC, c/o International Marine Centre, LocalitГЎ Sa Mardini, 09072
Torregrande, Oristano, Italy. paolo.domenici@iamc.cnr.it
Hypoxia is a phenomenon occurring in marine coastal areas with increasing
frequency. While hypoxia has been documented to affect fish activity and
metabolism, recent evidence shows that hypoxia can also have a detrimental effect
on various antipredator behaviours. Here, we review such evidence with a focus on
the effect of hypoxia on fish escape responses, its modulation by aquatic surface
respiration (ASR) and schooling behaviour. The main effect of hypoxia on escape
behaviour was found in responsiveness and directionality. Locomotor performance
in escapes was expected to be relatively independent of hypoxia, since escape
responses are fuelled anaerobically. However, hypoxia decreased locomotor
performance in some species (Mugilidae) although only in the absence of ASR in
severe hypoxia. ASR allows fish to show higher escape performance than fish
staying in the water column where hypoxia occurs. This situation provides a
trade-off whereby fish may perform ASR in order to avoid the detrimental effects
of hypoxia, although they would be subjected to higher exposure to aerial
predation. As a result of this trade-off, fishes appear to minimize surfacing
behaviour in the presence of aerial predators and to surface near shelters, where
possible. For many fish species, schooling can be an effective antipredator
behaviour. Severe hypoxia may lead to the disruption of the school unit. At
moderate levels, hypoxia can increase school volume and can change the shuffling
behaviour of individuals. By altering school structure and dynamics, hypoxia may
affect the well functioning of schooling in terms of synchronization and
execution of antipredator manoeuvres. School structure and volume appear to be
the results of numerous trade-offs, where school shape may be dictated by the
presence of predators, the need for energy saving via hydrodynamic advantages and
oxygen level. The effects of hypoxia on aquatic organisms can be taxon specific.
While hypoxia may not necessarily increase the vulnerability of fish subject to
predation by other fish (since feeding in fish also decreases in hypoxia),
predators from other taxa such as birds, jellyfish or aquatic mammals may take
advantage of the detrimental effects of hypoxia on fish escape ability.
Therefore, the effect of hypoxia on fish antipredator behaviours may have major
consequences for the composition of aquatic communities.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17472921 [PubMed - in process]
45: Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004846.
Comment in:
Evid Based Dent. 2007;8(3):85-6.
Topical lidocaine for the treatment of postherpetic neuralgia.
Khaliq W, Alam S, Puri N.
BACKGROUND: The cause of postherpetic neuralgia is damage to peripheral neurons,
dorsal root ganglia, and the dorsal horn of the spinal cord, secondary to herpes
zoster infection (shingles). In postherpetic neuralgia, peripheral neurons
discharge spontaneously and have lowered activation thresholds, and exhibit an
exaggerated response to stimuli. Topical lidocaine dampens peripheral nociceptor
sensitisation and central nervous system hyperexcitability, and may benefit
patients with postherpetic neuralgia. OBJECTIVES: To examine the efficacy and
safety of topical lidocaine in the treatment of postherpetic neuralgia. SEARCH
STRATEGY: We searched the Cochrane Pain, Palliative and Supportive Care Group
Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, EMBASE, and LILACS, SIGLE for conference proceedings, Citation Index,
the reference lists of all eligible trials, key textbooks, and previous
systematic reviews. We also wrote to authors of all identified trials. SELECTION
CRITERIA: Randomised or quasi-randomised trials comparing all topical
applications of lidocaine, including gels and patches in patients of all ages
with postherpetic neuralgia (pain persisting at the site of shingles at least one
month after the onset of the acute rash). DATA COLLECTION AND ANALYSIS: Two
review authors extracted data, and a third checked them. We obtained some missing
data from the US Food and Drugs Administration. MAIN RESULTS: Three trials
involving 182 topical lidocaine treated participants and 132 control participants
were included. Two trials gave data on pain relief, and the remaining study
provided data on secondary outcome measures. The largest trial published as an
abstract compared topical lidocaine patch to a placebo patch and accounted for
150 of the 314 patients (48%).A meta-analysis combining two of the three studies
identified a significant difference between the topical lidocaine and control
groups for the primary outcome measure: a mean improvement in pain relief
according to a pain relief scale. Topical lidocaine relieved pain better than
placebo (P = 0.003).There was a statistical difference between the groups for the
secondary outcome measure of mean VAS score reduction (P = 0.03), but this was
only for a single small trial. There were a similar number of adverse skin
reactions in both treatment and placebo groups.The highest recorded blood
lidocaine concentration varied between 59 ng/ml and 431 ng/ml between trials. The
latter figure is high and the authors of the study suggest that the sample had
been contaminated during the assay procedure. AUTHORS' CONCLUSIONS: There is
insufficient evidence to recommend topical lidocaine as a first-line agent in the
treatment of postherpetic neuralgia with allodynia. Further research should be
undertaken on the efficacy of topical lidocaine for other chronic neuropathic
pain disorders, and also to compare different classes of drugs (e.g. topical
anaesthetics versus anti-epileptics).
Publication Types:
Meta-Analysis
Review
PMID: 17443559 [PubMed - indexed for MEDLINE]
46: Clin Infect Dis. 2007 May 15;44(10):1280-8. Epub 2007 Apr 3.
Comment in:
Clin Infect Dis. 2007 Dec 1;45(11):1527-9.
Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic
neuralgia in older adults.
Rothberg MB, Virapongse A, Smith KJ.
Division of General Medicine and Geriatrics, Department of Medicine, Baystate
Medical Center, Springfield, MA 01199, USA. Michael.Rothberg@bhs.org
BACKGROUND: A vaccine to prevent herpes zoster was recently approved by the
United States Food and Drug Administration. We sought to determine the
cost-effectiveness of this vaccine for different age groups. METHODS: We
constructed a cost-effectiveness model, based on the Shingles Prevention Study,
to compare varicella zoster vaccination with usual care for healthy adults aged
>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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17443464 [PubMed - indexed for MEDLINE]
47: Cent Afr J Med. 2005 May-Jun;51(5-6):53-8.
Preterm delivery risk in relation to maternal HIV infection, history of malaria
and other infections among urban Zimbabwean women.
Noble A, Ning Y, Woelk GB, Mahomed K, Williams MA.
Department Of Epidemiology, University of Washington School of Public Health and
Community Medicine, Seattle, USA.
OBJECTIVE: To examine preterm delivery risk in relation to maternal HIV
infection, malaria history, and other infections among Zimbabwean women. DESIGN:
Hospital based, cross sectional study. SETTING: Harare Maternity Hospital,
Harare, Zimbabwe. SUBJECTS: A convenient sample of 500 pregnant women. MAIN
OUTCOME MEASURE: Preterm delivery. THE STUDY FACTORS: Maternal socio-demographic
information, and infectious disease history (during the year before pregnancy).
METHOD: Between July 1998 and March 1999 data were collected for a cross
sectional study of pregnant women who delivered at the Harare Maternal Hospital.
The association of maternal HIV infection, history of malaria, and other
infections with preterm delivery were determined using multivariate analysis.
RESULTS: Overall, 497 women were studied, 444 (89.3%) delivered at term and 53
women (10.7%) delivered preterm. Women who delivered preterm were less likely to
be HIV seropositive compared with others (odds ratio [OR] = 0.75. 95% confidence
interval (CI): 0.38 to 21.48). Preterm delivery was associated with having
tuberculosis infections in the year prior to the pregnancy (OR = 10.15, 95% CI:
1.15 to 89.87). Other infections associated with preterm delivery were malaria
(OR = 2.39, 95% CI: 1.07 to 5.31), chest infections (OR = 2.63, 95% CI: 0.76 to
9.17), and Herpes (shingles) infection (OR = 2.58, 95% CI: 0.56 to 11.85).
Overall, a positive history of any of the non-sexually transmitted infections (in
aggregate) was associated with a 3.20 fold increase risk for preterm delivery (OR
= 3.20. 95% CI: 1.59 to 6.43). Women with a history of infection and who did not
use iron supplements during pregnancy, compared with women without such an
history and who used iron supplements, experienced the highest risk for preterm
delivery (OR = 8.34, 95% CI: 3.30 to 21.07). CONCLUSION: Maternal non-STD
infections, (i.e., tuberculosis, malaria, and chest infections) occurring in the
year prior to pregnancy were associated with an increased risk of preterm
delivery. The association of non-sexually transmitted infections and preterm
delivery was particularly strong among women who did not use iron supplements
during pregnancy.
PMID: 17432432 [PubMed - indexed for MEDLINE]
48: 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.
Publication Types:
Case Reports
PMID: 17380914 [PubMed - indexed for MEDLINE]
49: Mich Med. 2007 Jan-Feb;106(1):12-3.
ACIP recommends vaccine to prevent shingles.
[No authors listed]
PMID: 17375694 [PubMed - indexed for MEDLINE]
50: 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.
PMID: 17357357 [PubMed - indexed for MEDLINE]
51: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17356546 [PubMed - indexed for MEDLINE]
52: CBE Life Sci Educ. 2007 Spring;6(1):65-73.
Exploring DNA structure with Cn3D.
Porter SG, Day J, McCarty RE, Shearn A, Shingles R, Fletcher L, Murphy S,
Pearlman R.
Geospiza, Inc., Seattle, WA 98107, USA. sandy@geospiza.com
Researchers in the field of bioinformatics have developed a number of analytical
programs and databases that are increasingly important for advancing biological
research. Because bioinformatics programs are used to analyze, visualize, and/or
compare biological data, it is likely that the use of these programs will have a
positive impact on biology education. Over the past years, we have been working
to help biology instructors introduce bioinformatics activities into their
curricula by providing them with instructional materials that use bioinformatics
programs and databases as educational tools. In this study, we measured the
impact of a set of these materials on student learning. The activities in these
materials asked students to use the molecular structure visualization program
Cn3D to locate, identify, or analyze diverse features in DNA structures. Both the
experimental groups of college and high school students showed significant
increases in learning relative to control groups. Further, learning gains by the
college students were correlated with the number of activities assigned. We
conclude that working with Cn3D was important for improving student understanding
of DNA structure. This study is one example of how a bioinformatics program for
visualization can be used to support student learning.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 17339395 [PubMed - indexed for MEDLINE]
53: Eur J Pediatr. 2008 Jan;167(1):47-55. Epub 2007 Mar 3.
Varicella vaccination in Europe: are we ready for a universal childhood
programme?
Sengupta N, Booy R, Schmitt HJ, Peltola H, Van-Damme P, Schumacher RF, Campins M,
Rodrigo C, Heikkinen T, Seward J, Jumaan A, Finn A, OlcГ©n P, Thiry N,
Weil-Olivier C, Breuer J.
Centre for Child Health, Royal London Hospital, 38 New Road, Whitechapel, London,
E1 2AX, UK.
Safe and effective vaccines against varicella zoster virus (VZV), the
aetiological agent of varicella and shingles, have been available in Europe for
the last 5-10 years. The USA has had a universal childhood vaccination policy
since 1995 and this has resulted in a dramatic decrease in the incidence,
morbidity and mortality related to varicella. The economic and medical burden of
VZV has led to discussions regarding both the desirability and feasability of a
similar routine immunisation policy for all European children. This article
examines the epidemiology of varicella in Europe and how the data emerging from
the USA can be used to achieve adequate prevention of the disease. It looks into
the current evidence of the health economic evaluation of universal varicella
vaccination and explores the concerns surrounding such a policy, including the
postulated impact on the incidence of zoster. In conclusion, the Society of
Independent European Vaccination Experts (SIEVE) recommends that the immunisation
of susceptible adolescents needs to be urgently implemented, in addition to the
current recommendations targeting high-risk patients, their close contacts with a
negative history of varicella and seronegative health-care workers. A universal
policy, optimally incorporating a two-dose schedule, will be needed to finally
reduce the burden of disease of varicella from a societal point of view. The
SIEVE recommends the implementation of such a policy as soon as financially and
practically possible.
PMID: 17334784 [PubMed - in process]
54: 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]
55: Iran J Allergy Asthma Immunol. 2005 Jun;4(2):95-8.
The Seroepidemiology of Varicella Zoster Virus (VZV) in Different Age Groups in
Tehran, Iran.
Sharifi Z, Emadi Ghanjin S.
Research Center of Iranian Blood Transfusion Organization (IBTO), Tehran, Iran.
sharifiz@yahoo.com.
Varicella zoster virus (VZV), the causative agent of chicken pox and shingles,
can cause severe systemic infections of the CNS and the respiratory tract in
immunocompetent individuals as well as in immunocompromized patients.The aim of
this cross-sectional study was to assess the prevalence of antibody Varicella
zoster virus in different age groups.The enzyme linked immunosorbent assay
(ELISA) method was used to assess the presence of anti -VZV antibody.A total of
635 serum samples were collected. Age specific prevalence of IgG antibody to VZV
showed a progressive increase with age in both males and females. The overall
seroprevalence rate was 83.6%. Prevalence of antibodies was 59.7% in the age
group of less than 10 years, 60.4 % in 10-14 years, 87.5 % in 15-19 years, 88 %
in 20-24 years, 89.4 % in 25-29 years and 87.9 % in 30-39 years.The data show
that children should be considered as a target group for prevention programs
against VZV infection.
PMID: 17301429 [PubMed - in process]
56: J Environ Sci (China). 2006;18(6):1193-8.
Investigation on Fe, Mn, Zn, Cu, Pb and Cd fractions in the natural surface
coating samples and surficial sediments in the Songhua River, China.
Guo SH, Wang XL, Li Y, Chen JJ, Yang JC.
Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang 110016,
China. shuhaiguo@iae.ac.cn
Natural surface coating samples (NSCSs) from the surface of shingles and
surficial sediments (SSs) in the Songhua River, China were employed to
investigate the relationship between NSCSs and SSs in fractions of heavy metals
(Fe, Mn, Zn, Cu, Pb, and Cd) using the modified sequential extraction procedure
(MSEP). The results show that the differences between NSCSs and SSs in Fe
fractions were insignificant and Fe was dominantly present as residual phase
(76.22% for NSCSs and 80.88% for SSs) and Fe-oxides phase (20.33% for NSCSs and
16.15% for SSs). Significant variation of Mn distribution patterns between NSCSs
and SSs was observed with Mn in NSCSs mainly present in Mn-oxides phase (48.27%)
and that in SSs present as residual phase (45.44%). Zn, Cu, Pb and Cd were found
dominantly in residual fractions (>48%), and next in solid oxides/hydroxides for
Zn, Pb and Cd and in easily oxidizable solids/compounds form for Cu,
respectively. The heavy metal distribution patterns implied that Fe/Mn oxides
both in NSCSs and SSs were more important sinks for binding and adsorption of Zn,
Pb and Cd than organic matter (OM), and inversely, higher affinity of Cu to OM
than Fe/Mn oxides in NSCSs and SSs was obtained. Meanwhile, it was found that the
distributions of heavy metals in NSCSs and SSs were similar to each other and the
pseudo-total concentrations of Zn, Cu, Pb and Cd in NSCSs were greater than those
in SSs, highlighting the more importance for NSCSs than SSs in controlling
behaviours of heavy metals in aquatic environments.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17294964 [PubMed - indexed for MEDLINE]
57: 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
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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17291380 [PubMed - indexed for MEDLINE]
58: 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 MГ©decine Interne, HГґpital Ambroise-ParГ©, UniversitГ©
Versailles-Saint-Quentin-en-Yvelines, Assistance publique-HГґpitaux 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.
Publication Types:
English Abstract
Review
PMID: 17270316 [PubMed - indexed for MEDLINE]
59: BMC Genomics. 2007 Jan 23;8:27.
Insight into transcription factor gene duplication from Caenorhabditis elegans
Promoterome-driven expression patterns.
Reece-Hoyes JS, Shingles J, Dupuy D, Grove CA, Walhout AJ, Vidal M, Hope IA.
Institute of Integrative and Comparative Biology, Faculty of Biological Sciences,
University of Leeds, Clarendon Way, Leeds, LS2 9JT, West Yorkshire, UK.
John.Reece-Hoyes@umassmed.edu <John.Reece-Hoyes@umassmed.edu>
BACKGROUND: The C. elegans Promoterome is a powerful resource for revealing the
regulatory mechanisms by which transcription is controlled pan-genomically.
Transcription factors will form the core of any systems biology model of genome
control and therefore the promoter activity of Promoterome inserts for C. elegans
transcription factor genes was examined, in vivo, with a reporter gene approach.
RESULTS: Transgenic C. elegans strains were generated for 366 transcription
factor promoter/gfp reporter gene fusions. GFP distributions were determined, and
then summarized with reference to developmental stage and cell type. Reliability
of these data was demonstrated by comparison to previously described gene product
distributions. A detailed consideration of the results for one C. elegans
transcription factor gene family, the Six family, comprising ceh-32, ceh-33,
ceh-34 and unc-39 illustrates the value of these analyses. The high proportion of
Promoterome reporter fusions that drove GFP expression, compared to previous
studies, led to the hypothesis that transcription factor genes might be involved
in local gene duplication events less frequently than other genes. Comparison of
transcription factor genes of C. elegans and Caenorhabditis briggsae was
therefore carried out and revealed very few examples of functional gene
duplication since the divergence of these species for most, but not all,
transcription factor gene families. CONCLUSION: Examining reporter expression
patterns for hundreds of promoters informs, and thereby improves, interpretation
of this data type. Genes encoding transcription factors involved in intrinsic
developmental control processes appear acutely sensitive to changes in gene
dosage through local gene duplication, on an evolutionary time scale.
Publication Types:
Research Support, N.I.H., Extramural
PMID: 17244357 [PubMed - indexed for MEDLINE]
60: Drugs Aging. 2007;24(1):1-19.
Post-herpetic neuralgia in older adults: evidence-based approaches to clinical
management.
Christo PJ, Hobelmann G, Maine DN.
Department of Anesthesiology and Critical Care Medicine, Division of Pain
Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
21205, USA. pchristo@jhmi.edu
Many individuals across the globe have been exposed to the varicella-zoster virus
(VZV) that causes chickenpox. After chickenpox has resolved, the virus remains
latent in the dorsal root ganglia where it can re-emerge later in life as herpes
zoster, otherwise known as shingles. Herpes zoster is a transient disease
characterised by a dermatomal rash that is usually associated with significant
pain. Post-herpetic neuralgia (PHN) is the term used for the condition that
exists if the pain persists after the rash has resolved. Advanced age and
compromised cell-mediated immunity are significant risk factors for reactivation
of herpes zoster and the subsequent development of PHN. Though the
pathophysiology of PHN is unclear, studies suggest peripheral and central
demyelination as well as neuronal destruction are involved. Both the vaccine
against VZV (Varivax) and the newly released vaccine against herpes zoster
(Zostavax) may lead to substantial reductions in morbidity from herpes zoster and
PHN. In addition, current evidence suggests that multiple medications are
effective in reducing the pain associated with PHN. These include tricyclic
antidepressants, antiepileptics, opioids, NMDA receptor antagonists as well as
topical lidocaine (lignocaine) and capsaicin. Reasonable evidence supports the
use of intrathecal corticosteroids, but the potential for neurological sequelae
should prompt caution with their application. Epidural corticosteroids have not
been shown to provide effective analgesia for PHN. Sympathetic blockade may
assist in treating the pain of herpes zoster or PHN. For intractable PHN pain,
practitioners have performed delicate surgeries and attempted novel therapies.
Although such therapies may help reduce pain, they have been associated with
disappointing results, with up to 50% of patients failing to receive acceptable
pain relief. Hence, it is likely that the most effective future treatment for
this disease will focus on prevention of VZV infection and immunisation against
herpes zoster infection with a novel vaccine.
Publication Types:
Review
PMID: 17233544 [PubMed - indexed for MEDLINE]
61: 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]
62: 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.
Publication Types:
Multicenter Study
Randomized Controlled Trial
PMID: 17227688 [PubMed - indexed for MEDLINE]
63: 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]
64: 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.
Publication Types:
Randomized Controlled Trial
PMID: 17182505 [PubMed - indexed for MEDLINE]
65: 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]
66: Arch Virol. 2007;152(3):553-63. Epub 2006 Nov 20.
Simian varicella virus gene 61 encodes a viral transactivator but is
non-essential for in vitro replication.
Gray WL, Davis K, Ou Y, Ashburn C, Ward TM.
Department of Microbiology and Immunology, University of Arkansas for Medical
Sciences, Little Rock, AR 72205, USA. graywaynel@uams.edu
Simian varicella virus (SVV) is closely related to varicella-zoster virus (VZV),
the causative agent of chickenpox and shingles. The SVV and VZV gene 61
polypeptides are homologs of the HSV-1 ICP0, a viral transactivator which appears
to play a role in viral latency and reactivation. In this study, the molecular
properties of the SVV 61 were characterized. The SVV open reading frame (ORF) 61
encodes a 54.1-kDa polypeptide with 37% amino acid identity to the VZV 61.
Homology to the HSV-1 ICP-0 is limited to a conserved RING finger motif at the
amino terminus of the protein. A nuclear localization sequence (nls) at the
carboxy-terminus directs the SVV 61 to the cell nucleus, while a SVV 61nls(-)
mutant is confined to the cell cytoplasm. The SVV 61 transactivates its own
promoter as well as SVV immediate early (IE, ORF 62), early (ORFs 28 and 29), and
late (ORF 68) gene promoters in transfected Vero cells. The RING finger and nls
motifs are required for efficient SVV 61 transactivation. The SVV 61 has no
effect on the ability of the major SVV transactivator (IE62) to induce SVV
promoters. Generation and propagation of a SVV gene 61 deletion mutant
demonstrated that the SVV 61 is non-essential for in vitro replication. SVV gene
61 is expressed in liver, lung, and neural ganglia of infected monkeys during
acute simian varicella.
Publication Types:
Research Support, N.I.H., Extramural
PMID: 17115302 [PubMed - indexed for MEDLINE]
67: Med Hypotheses. 2007;68(5):1059-64. Epub 2006 Nov 17.
Alzheimer's disease Braak Stage progressions: reexamined and redefined as
Borrelia infection transmission through neural circuits.
MacDonald AB.
St. Catherine of Siena Medical Center, Department of Pathology, 50 Rte 25 A,
Smithtown, NY 11787, USA. inmacdonald@yahoo.com
Brain structure in health is a dynamic energized equation incorporating
chemistry, neuronal structure, and circuitry components. The chemistry "piece" is
represented by multiple neurotransmitters such as Acetylcholine, Serotonin, and
Dopamine. The neuronal structure "piece" incorporates synapses and their
connections. And finally circuits of neurons establish "architectural blueprints"
of anatomic wiring diagrams of the higher order of brain neuron organizations. In
Alzheimer's disease, there are progressive losses in all of these components.
Brain structure crumbles. The deterioration in Alzheimer's is ordered,
reproducible, and stepwise. Drs. Braak and Braak have described stages in the
Alzheimer disease continuum. "Progressions" through Braak Stages benchmark
"Regressions" in Cognitive function. Under the microscope, the Stages of Braak
commence in brain regions near to the hippocampus, and over time, like a tsunami
wave of destruction, overturn healthy brain regions, with neurofibrillary tangle
damaged neurons "marching" through the temporal lobe, neocortex and occipital
cortex. In effect the destruction ascends from the limbic regions to
progressively destroy the higher brain centers. Rabies infection also "begins low
and finishes high" in its wave of destruction of brain tissue. Herpes Zoster
infections offer the paradigm of clinical latency of infection inside of nerves
before the "marching commences". Varicella Zoster virus enters neurons in the
pediatric years. Dormant virus remains inside the neurons for 50-80 years, tissue
damage late in life (shingles) demonstrates the "march of the infection" down
neural pathways (dermatomes) as linear areas of painful blisters loaded with
virus from a childhood infection. Amalgamation of Zoster with Rabies models
produces a hybrid model to explain all of the Braak Stages of Alzheimer's disease
under a new paradigm, namely "Alzheimer's neuroborreliosis" in which latent
Borrelia infections ascend neural circuits through the hippocampus to the higher
brain centers, creating a trail of neurofibrillary tangle injured neurons in
neural circuits of cholinergic neurons by transsynaptic transmission of infection
from nerve to nerve.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17113237 [PubMed - indexed for MEDLINE]
68: 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 fГјr Dermatologie und Allergologie am Biederstein,
Technische Universität München. moehrenschlager@lrz.tum.de
Publication Types:
Case Reports
PMID: 17059198 [PubMed - indexed for MEDLINE]
69: 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.
Publication Types:
Research Support, N.I.H., Intramural
PMID: 17055432 [PubMed - indexed for MEDLINE]
70: Mayo Clin Womens Healthsource. 2006 Nov;10(11):3.
FDA approves shingles vaccine for older adults.
[No authors listed]
Publication Types:
News
PMID: 17047564 [PubMed - indexed for MEDLINE]
71: Lancet. 2006 Oct 14;368(9544):1365-76.
Erratum in:
Lancet. 2007 Feb 17;369(9561):558.
Comment in:
Lancet. 2006 Dec 23;368(9554):2208. Lancet. 2006 Dec 23;368(9554):2208-9.
Varicella.
Heininger U, Seward JF.
Division of Paediatric Infectious Diseases and Vaccinology, University Children's
Hospital, Basel, Switzerland. Ulrich.Heininger@unibas.ch
Varicella-zoster virus, a herpesvirus, causes varicella (chickenpox) and, after
endogenous reactivation, herpes zoster (shingles). Varicella, which is recognised
by a characteristic vesicular rash, arises mainly in young children, although
older individuals can be affected. In immunocompetent patients, symptoms are
usually mild to moderate, but an uncomplicated severe case can have more than
1000 lesions and severe constitutional symptoms. Serious complications--including
central nervous system involvement, pneumonia, secondary bacterial infections,
and death--are sometimes seen. Varicella can be prevented by vaccination. Vaccine
is about 80-85% effective against all disease and highly (more than 95%)
effective in prevention of severe disease. In the USA, a routine childhood
immunisation programme has reduced disease incidence, complications, hospital
admissions, and deaths in children and in the general population, indicating
strong herd immunity. Similar immunisation programmes have been adopted by some
other countries, including Uruguay, Germany, Taiwan, Canada, and Australia, and
are expected to be implemented more widely in future.
Publication Types:
Review
PMID: 17046469 [PubMed - indexed for MEDLINE]
72: Nurs Older People. 2006 Oct;18(9):20-2.
Shingles: relief at last.
Dinsdale P.
PMID: 17042348 [PubMed - indexed for MEDLINE]
73: 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]
74: J Exp Biol. 2006 Oct;209(Pt 20):4174-84.
Escape responses in juvenile Atlantic cod Gadus morhua L.: the effects of
turbidity and predator speed.
Meager JJ, Domenici P, Shingles A, Utne-Palm AC.
Department of Biology, University of Bergen, PO Box 7800, Bergen N-5020, Norway.
Justin.Meager@bio.uib.no
We examined the effect of turbidity (0.5-14 beam attenuation m(-1)) and predator
attack speed (150 and 296 cm s(-1)) on escape responses of juvenile cod Gadus
morhua in the laboratory. We triggered escape responses using a predator model
and measured escape timing, direction and locomotor performance. We also measured
responsiveness and estimated the likelihood of fish escaping the ;predator
attack' (putative escape success, PES). Turbidity affected both PES and the type
of escape response used by the fish, but these effects depended on predator
speed. PES for the fast predator attack declined from 73% in clear water to 21%
in highly turbid water, due to decreased responsiveness and poorly timed escapes.
Intermediate turbidity enhanced PES and responsiveness to the slow predator
attack. Locomotor performance was reduced by turbidity, whereas predator speed
had the opposite effect. Our results suggest that both predator attack speed and
turbidity have important roles in determining the vulnerability of fish attacked
by piscivorous predators.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17023610 [PubMed - indexed for MEDLINE]
75: 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.
Publication Types:
Case Reports
PMID: 17019453 [PubMed - indexed for MEDLINE]
76: Pancreas. 2006 Oct;33(3):314-5.
Shingles-associated Pancreatitis.
Famularo G, Minisola G, Nicotra GC.
Publication Types:
Case Reports
Letter
PMID: 17003657 [PubMed - indexed for MEDLINE]
77: Exp Parasitol. 2007 Feb;115(2):114-20. Epub 2006 Sep 22.
Meloidogyne incognita: molecular and biochemical characterisation of a cathepsin
L cysteine proteinase and the effect on parasitism following RNAi.
Shingles J, Lilley CJ, Atkinson HJ, Urwin PE.
Centre for Plant Sciences, University of Leeds, Leeds LS2 9JT, UK.
RNA interference has been used to investigate the function of a cathepsin L
cysteine proteinase Mi-cpl-1, in the plant-parasitic nematode Meloidogyne
incognita. A reduction in gene transcript was observed and the number of
nematodes infecting plants was reduced by almost 60% as was the number of
established females producing eggs at 21 days post-infection. The cysteine
proteinase activity of M. incognita, reported by the substrate GLUpNA, was
inhibited by the cysteine proteinase inhibitor Oc-IDeltaD86. A reduction in
cysteine proteinase activity was also seen following RNAi of Mi-cpl-1 in J2 stage
nematodes. In situ hybridization analysis in young and mature female nematodes
has shown that Mi-cpl-1 is expressed in the intestine, which suggests that its
product is a digestive enzyme. The effects of knocking-out Mi-cpl-1gene function
were consistent with a reduction in feeding efficiency. Here, we have shown a
correlation between transcript abundance proteinase activity and parasitic
success of M. incognita.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 16996059 [PubMed - indexed for MEDLINE]
78: 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.
Publication Types:
Review
PMID: 16989624 [PubMed - indexed for MEDLINE]
79: Toxicon. 2006 Dec 1;48(7):810-29. Epub 2006 Jul 15.
Therapeutic applications of conotoxins that target the neuronal nicotinic
acetylcholine receptor.
Livett BG, Sandall DW, Keays D, Down J, Gayler KR, Satkunanathan N, Khalil Z.
Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and
Biotechnology Institute, University of Melbourne, Victoria 3010, Australia.
b.livett@unimelb.edu.au
Pain therapeutics discovered by molecular mining of the expressed genome of
Australian predatory cone snails are providing lead compounds for the treatment
of neurological diseases such as multiple sclerosis, shingles, diabetic
neuropathy and other painful neurological conditions. The high specificity
exhibited by these novel compounds for neuronal receptors and ion channels in the
brain and nervous system indicates the high degree of selectivity that this class
of neuropeptides can be expected to show when used therapeutically in humans. A
lead compound, ACV1 (conotoxin Vc1.1 from Conus victoriae), has entered Phase II
clinical trials and is being developed for the treatment for neuropathic pain.
ACV1 will be targeted initially for the treatment of sciatica, shingles and
diabetic neuropathy. The compound is a 16 amino acid peptide [Sandall et al.,
2003. A novel alpha-conotoxin identified by gene sequencing is active in
suppressing the vascular response to selective stimulation of sensory nerves in
vivo. Biochemistry 42, 6904-6911], an antagonist of neuronal nicotinic
acetylcholine receptors. It has potent analgesic activity following subcutaneous
or intramuscular administration in several preclinical animal models of human
neuropathic pain [Satkunanathan et al., 2005. Alpha conotoxin Vc1.1 alleviates
neuropathic pain and accelerates functional recovery of injured neurons. Brain.
Res. 1059, 149-158]. ACV1 may act as an analgesic by decreasing ectopic
excitation in sensory nerves. In addition ACV1 appears to accelerate the recovery
of injured nerves and tissues.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 16979678 [PubMed - indexed for MEDLINE]
80: 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]
81: Ann Intern Med. 2006 Sep 5;145(5):386-7.
Comment on:
Ann Intern Med. 2006 Sep 5;145(5):317-25.
Shingles vaccine: effective and costly or cost-effective?
Koplan JP, Harpaz R.
Publication Types:
Comment
Editorial
PMID: 16954362 [PubMed - indexed for MEDLINE]
82: Ann Intern Med. 2006 Sep 5;145(5):317-25.
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.
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
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]
83: Ann Intern Med. 2006 Sep 5;145(5):I14.
Original report in:
Ann Intern Med. 2006 Sep 5;145(5):317-25.
Summaries for patients. Cost-effectiveness of a vaccine to prevent herpes zoster
(shingles) in older adults.
[No authors listed]
Publication Types:
Patient Education Handout
PMID: 16954354 [PubMed - indexed for MEDLINE]
84: 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]
85: 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]
86: 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.
Publication Types:
Review
PMID: 16936604 [PubMed - indexed for MEDLINE]
87: 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.
Publication Types:
Case Reports
PMID: 16927898 [PubMed - indexed for MEDLINE]
88: Health News. 2006 Aug;12(8):2.
Shingles vaccine gets the FDA nod.
[No authors listed]
Publication Types:
News
PMID: 16917965 [PubMed - indexed for MEDLINE]
89: Med Hypotheses. 2006;67(6):1411-3. Epub 2006 Aug 4.
Role of bacterial superinfections in the pathogenesis of postzosteric neuralgia.
Bassukas ID, Kiorpelidou D.
Department of Skin and Venereal Diseases, University Hospital of Ioannina,
University of Ioannina, Medical School, S. Niarhos Avenue, 45500 Ioannina,
Greece. ibassuka@cc.uoi.gr
Varicella-zoster virus (VZV) is an alpha-herpes virus that causes varicella
(chickenpox), establishes latency in dorsal root ganglia and may reactivate to
cause herpes zoster (shingles). Postherpetic neuralgia is the most common
debilitating complication of herpes zoster. It is currently supposed that
scarring of the dorsal root ganglia and atrophy of the dorsal horn as a result of
intense inflammation may play a central role in the pathogenesis of this
condition. The exact pathogenesis of the inflammatory reaction leading to
persistent ganglion damage is still poorly understood. However, immune
suppression is a recognized risk factor for the development of postzosteric
neuralgia in zoster patients (increased risk, e.g., in aged patients over 80
years or diabetes mellitus patients). There is some evidence that remote
streptococcal and staphylococcal infections may induce immunologic disease
mechanisms consequently affecting the central nervous system. Since streptococcal
and/or staphylococcal superinfection of skin lesions is common in herpes zoster,
we present a hypothesis of immunopathogenesis of postzosteric neuralgia, i.e., as
the result of augmentation of local ganglion inflammation due to bacteria-driven
clonal expansion of VZV-specific T-cell subsets in the affected skin. Based on
the aforementioned hypothesis it is interesting: (1) to study the impact of
concomitant systemic antibiotic treatment to the standard antiviral regimen on
the rate and severity of both bacterial superinfection of zoster skin lesions and
postzosteric neuralgia and (2) to quantify the VZV-specific T-cell response as a
function of the degree of bacterial superinfection of zoster skin lesions.
Challenging of the present hypothesis should provide an effective means of
preventing postherpetic neuralgia by preventing and consequently treating the
bacterial superinfection of zoster skin lesions.
PMID: 16890379 [PubMed - indexed for MEDLINE]
90: 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]
91: 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
Publication Types:
Review
PMID: 16872125 [PubMed - indexed for MEDLINE]
92: Health News. 2006 Jul;12(7):5-6.
Easing the pain of shingles.
[No authors listed]
Publication Types:
News
PMID: 16858750 [PubMed - indexed for MEDLINE]
93: Pain Physician. 2004 Jul;7(3):345-7.
Response of intractable post herpetic neuralgia to intrathecal baclofen.
Hosny A, Simopoulos T, Collins B.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
ahosny@svcmcny.org
An intractable case of Post-herpetic Neuralgia (PHN) in which all other treatment
options were exhausted was successfully treated with intrathecal baclofen
infusion with a complex continuous delivery mode. A 72-year old man presented to
the pain clinic with a 4-year history of left lower extremity PHN. He had seen
multiple experts in the field, failed numerous pharmacological therapies, and
interventional techniques. After multiple neuraxial medications were tried,
baclofen was chosen and an intrathecal drug delivery system was implanted. Eight
months after the procedure he continues to have 80 % pain relief. PHN is a
devastating complication of shingles. Fortunately, most cases respond to
conventional therapies. For intractable cases intrathecal baclofen appears to be
a safe and effective therapeutic modality.
PMID: 16858473 [PubMed]
94: JAMA. 2006 Jul 12;296(2):157-8.
FDA approves shingles vaccine: herpes zoster vaccine targets older adults.
Mitka M.
Publication Types:
News
PMID: 16835412 [PubMed - indexed for MEDLINE]
95: 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.
Publication Types:
Review
PMID: 16813460 [PubMed - indexed for MEDLINE]
96: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 16791838 [PubMed - indexed for MEDLINE]
97: 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]
98: 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.
Publication Types:
Case Reports
PMID: 16778668 [PubMed - indexed for MEDLINE]
99: Med Trop (Mars). 2006 Apr;66(2):167-71.
[Opportunistic diseases in HIV-infected patients at the Jeanne Ebori Foundation
in Libreville, Gabon]
[Article in French]
Okome-Nkoumou M, Boguikouma JB, Kombila M.
DГ©partement de mГ©decine interne et spГ©cialitГ©s mГ©dicales, UniversitГ© des Sciences
de la Sante , Libreville, Gabon. okomem@hotmail.com
The purpose of this study was to determine the frequencies of opportunistic
diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville,
Gabon. A total 6313 file of patients treated in the internal medicine unit
between 1994 and 1998 were analyzed. Findings showed that the main diseases
related to AIDS classified according to seroprevalence were as follows: purigo
(100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia
(87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main
diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid
(9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%),
and malaria (14%). In addition to these diseases there were nine cases of
Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two
cases of herpes Varicella, one case of cryptosporidiosis, and one case of
isosporosis. The incidence of opportunistic disease was high in our study and
must be taken in drug procurement.
Publication Types:
English Abstract
PMID: 16775941 [PubMed - indexed for MEDLINE]
100: 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.
Publication Types:
Case Reports
PMID: 16763386 [PubMed - indexed for MEDLINE]
101: Arch Neurol. 2006 Jul;63(7):940-2. Epub 2006 May 8.
Improvement of postherpetic neuralgia after treatment with intravenous acyclovir
followed by oral valacyclovir.
Quan D, Hammack BN, Kittelson J, Gilden DH.
Department of Neurology, University of Colorado Health Sciences Center, Denver,
Colorado 80262, USA.
BACKGROUND: Postherpetic neuralgia (PHN) is a complication of shingles (herpes
zoster), a painful rash due to varicella-zoster virus reactivation. Studies of
patients with PHN and zoster sine herpete (radicular pain without rash) support
the notion that low-grade viral ganglionitis contributes to pain. If chronic pain
reflects active infection, then antiviral therapy may help patients with PHN.
OBJECTIVE: To determine whether antiviral treatment helps reduce PHN-associated
pain. DESIGN: Prospective, open-label phase I/II clinical trial. SETTING:
Tertiary care university hospital. PATIENTS: Fifteen patients with moderate to
severe PHN. INTERVENTIONS: Intravenous acyclovir at a dosage of 10 mg/kg every 8
hours for 14 days followed by oral valacyclovir at a dosage of 1000 mg 3 times
per day for 1 month. MAIN OUTCOME MEASURE: Numeric Rating Scale for Pain score.
RESULTS: As defined by a decrease of 2 or more points on the Numeric Rating Scale
for Pain, 8 (53%) of 15 patients reported improvement. CONCLUSION: Clinical
improvement reported by most of our patients warrants further investigation in a
larger, randomized, double-blind, placebo-controlled trial.
Publication Types:
Clinical Trial, Phase I
Clinical Trial, Phase II
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 16682531 [PubMed - indexed for MEDLINE]
102: 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.
Publication Types:
Review
PMID: 16679476 [PubMed - indexed for MEDLINE]
103: 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]
104: Clin Infect Dis. 2006 Jun 1;42(11):1639-46. Epub 2006 Apr 28.
Comment in:
Clin Infect Dis. 2007 Jan 1;44(1):147-8; author reply 148-9.
Immune reconstitution syndrome in HIV: validating a case definition and
identifying clinical predictors in persons initiating antiretroviral therapy.
Robertson J, Meier M, Wall J, Ying J, Fichtenbaum CJ.
Department of Internal Medicine, Division of Infectious Diseases, University of
Cincinnati College of Medicine, Cincinnati, Ohio 45267-0560, USA.
roberj5@ucmail.uc.edu
BACKGROUND: Clinical deterioration after initiation of antiretroviral therapy may
result from restored immunity. There is no standard clinical definition for
immune reconstitution syndrome. The objectives of this study were to validate a
proposed definition and to identify factors predictive of immune reconstitution
syndrome. METHODS: This was a retrospective case-control study from an academic
university medical practice. Cases were matched to > or =2 control subjects by
CD4+ cell count at the time of initiation of antiretroviral therapy. Cases and
"mock cases" were blindly reviewed by 2 human immunodeficiency virus (HIV)
experts. RESULTS: Twenty possible cases of immune reconstitution syndrome were
identified; HIV experts excluded all cases of herpes zoster (shingles), with
agreement on real and mock cases of 92%. For 14 confirmed case patients (compared
with 40 control subjects), immune reconstitution syndrome was associated with a
higher number of prior opportunistic infections (P=.003) and higher CD8+ cell
counts at baseline (P=.05) and at week 12 (P=.02). Immune reconstitution syndrome
was associated with lower baseline levels of alanine aminotransferase (P=.05) and
hemoglobin (P=.02). On multivariate analysis, the number of prior opportunistic
infections (odds ratio, 2.7; P=.007) and lower hemoglobin level at baseline (odds
ratio, 0.8; P=.003) were independently associated with development of immune
reconstitution syndrome. A predictive model was defined by classification and
regression tree analysis with a sensitivity and specificity of 78.57% and 87.50%,
respectively, for an importance score of > or =4 (on a scale of 0.0 to 100.0),
and 92.86% and 80.00%, respectively, for a score of > or =2, using the number of
prior opportunistic infections, CD8+ cell count, and hemoglobin level.
CONCLUSIONS: A standard definition for immune reconstitution syndrome is
possible. Patients with a greater severity of illness at initiation of
antiretroviral therapy are at risk for immune reconstitution syndrome. The model
defined by classification and regression tree analysis may provide a basis for
risk stratification before initiation of antiretroviral therapy.
Publication Types:
Research Support, N.I.H., Extramural
PMID: 16652323 [PubMed - indexed for MEDLINE]
105: 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.
Publication Types:
Case Reports
PMID: 16651676 [PubMed - indexed for MEDLINE]
106: J Biol Chem. 2006 Jun 30;281(26):18193-200. Epub 2006 Apr 24.
Crystal structure of the herpes simplex virus 1 DNA polymerase.
Liu S, Knafels JD, Chang JS, Waszak GA, Baldwin ET, Deibel MR Jr, Thomsen DR,
Homa FL, Wells PA, Tory MC, Poorman RA, Gao H, Qiu X, Seddon AP.
Exploratory Medicinal Sciences, Pfizer Inc., Eastern Point Road, Groton, CT
06340, USA. shenping.liu@pfizer.com
Herpesviruses are the second leading cause of human viral diseases. Herpes
Simplex Virus types 1 and 2 and Varicella-zoster virus produce neurotropic
infections such as cutaneous and genital herpes, chickenpox, and shingles.
Infections of a lymphotropic nature are caused by cytomegalovirus, HSV-6, HSV-7,
and Epstein-Barr virus producing lymphoma, carcinoma, and congenital
abnormalities. Yet another series of serious health problems are posed by
infections in immunocompromised individuals. Common therapies for herpes viral
infections employ nucleoside analogs, such as Acyclovir, and target the viral DNA
polymerase, essential for viral DNA replication. Although clinically useful, this
class of drugs exhibits a narrow antiviral spectrum, and resistance to these
agents is an emerging problem for disease management. A better understanding of
herpes virus replication will help the development of new safe and effective
broad spectrum anti-herpetic drugs that fill an unmet need. Here, we present the
first crystal structure of a herpesvirus polymerase, the Herpes Simplex Virus
type 1 DNA polymerase, at 2.7 A resolution. The structural similarity of this
polymerase to other alpha polymerases has allowed us to construct high confidence
models of a replication complex of the polymerase and of Acyclovir as a DNA chain
terminator. We propose a novel inhibition mechanism in which a representative of
a series of non-nucleosidic viral polymerase inhibitors, the
4-oxo-dihydroquinolines, binds at the polymerase active site interacting
non-covalently with both the polymerase and the DNA duplex.
PMID: 16638752 [PubMed - indexed for MEDLINE]
107: Nursing. 2006 Apr;36(4):18-9.
Shutting down shingles.
Snow M.
CNA Edicational Services, Kaysville, Utah, USA.
PMID: 16582721 [PubMed - indexed for MEDLINE]
108: 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, HahnГ© S, RГјmke 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]
109: Environ Pollut. 2006 Sep;143(2):221-7. Epub 2006 Feb 7.
Cu and Zn adsorption onto non-residual and residual components in the natural
surface coatings samples (NSCSs) in the Songhua River, China.
Li Y, Wang X, Guo S, Dong D.
Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang, Shenyang
110016, PR China. liyuxx@mail.jlu.edu.cn
Natural surface coatings samples (NSCSs) from the surface of river shingles were
employed to investigate the roles of non-residual and residual components of the
NSCSs in controlling Cu and Zn adsorption via the selective extraction techniques
and statistical analysis. The results indicate that the greatest contribution to
metals adsorption on a molar basis was from Mn oxides in the non-residual
fraction. Metals adsorption capacities of Mn oxides exceeded those of Fe oxides
by one order of magnitude, fewer roles were found attributing to adsorption by
organic materials (OM), and the estimated contribution of the residual fraction
to metals adsorption was insignificant. These results implied that Mn oxides were
the most important component in controlling heavy metals in aquatic environments.
Experiments with Cu and Zn adsorption measured together showed that Cu severely
interfered with Zn adsorption to the NSCSs and vice versa under the conditions of
the two coexisted ions adsorption.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 16457916 [PubMed - indexed for MEDLINE]
110: Genome Biol. 2005;6(13):R110. Epub 2005 Dec 30.
A compendium of Caenorhabditis elegans regulatory transcription factors: a
resource for mapping transcription regulatory networks.
Reece-Hoyes JS, Deplancke B, Shingles J, Grove CA, Hope IA, Walhout AJ.
Institute of Integrative and Comparative Biology, Faculty of Biological Sciences,
School of Biology, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
bgyjsr@leeds.ac.uk
BACKGROUND: Transcription regulatory networks are composed of interactions
between transcription factors and their target genes. Whereas unicellular
networks have been studied extensively, metazoan transcription regulatory
networks remain largely unexplored. Caenorhabditis elegans provides a powerful
model to study such metazoan networks because its genome is completely sequenced
and many functional genomic tools are available. While C. elegans gene
predictions have undergone continuous refinement, this is not true for the
annotation of functional transcription factors. The comprehensive identification
of transcription factors is essential for the systematic mapping of transcription
regulatory networks because it enables the creation of physical transcription
factor resources that can be used in assays to map interactions between
transcription factors and their target genes. RESULTS: By computational searches
and extensive manual curation, we have identified a compendium of 934
transcription factor genes (referred to as wTF2.0). We find that manual curation
drastically reduces the number of both false positive and false negative
transcription factor predictions. We discuss how transcription factor splice
variants and dimer formation may affect the total number of functional
transcription factors. In contrast to mouse transcription factor genes, we find
that C. elegans transcription factor genes do not undergo significantly more
splicing than other genes. This difference may contribute to differences in
organism complexity. We identify candidate redundant worm transcription factor
genes and orthologous worm and human transcription factor pairs. Finally, we
discuss how wTF2.0 can be used together with physical transcription factor clone
resources to facilitate the systematic mapping of C. elegans transcription
regulatory networks. CONCLUSION: wTF2.0 provides a starting point to decipher the
transcription regulatory networks that control metazoan development and function.
Publication Types:
Research Support, N.I.H., Extramural
PMID: 16420670 [PubMed - indexed for MEDLINE]
111: Dermatol Online J. 2005 Dec 1;11(3):8.
Infections in the elderly.
Scheinfeld N.
St Lukes Roosevelt Hospital Center, New York, USA. NSS32@Columbia.edu
As people age they experience more illness and this applies in particular to skin
infections. Pathogenic states that provide the milieu for infection are more
common in the elderly. Infections that occur more common in the elderly include
Gram-positive bacterial infections of the skin, intertriginous infections, herpes
zoster/shingles and onychomycosis. These will be reviewed in the article. Newer
treatments such as valacyclovir, famcyclovir, terbinafine and linezolid exist to
treat these infections. Recognizing the varying presentations enhances the health
and treatment of disease of elderly patients.
Publication Types:
Review
PMID: 16409904 [PubMed - indexed for MEDLINE]
112: 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]
113: 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.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 16213091 [PubMed - indexed for MEDLINE]
114: 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]
115: Harv Womens Health Watch. 2005 Aug;12(12):5.
Shingles vaccine shows promise in large trial.
[No authors listed]
Publication Types:
News
PMID: 16208771 [PubMed - indexed for MEDLINE]
116: 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]
117: Environ Health Perspect. 2005 Oct;113(10):1373-5.
Case report: occupationally related recurrent varicella (chickenpox) in a
hospital nurse.
Ku CH, Liu YT, Christiani DC.
School of Public Health, National Defense Medical Center, National Defense
University, Taipei, Taiwan.
Commonly accepted outcomes of varicella-zoster virus (VZV) infections include
chickenpox (primary) and shingles (recurrence or latency), as well lifetime
immunity against chickenpox. We report the case of a registered nurse who worked
in a neurologic surgery ward in a general hospital in Taipei, Taiwan. While
working there for approximately 1 year, she developed recurrent chickenpox after
caring for a paraparesis patient, who had herpes zoster during hospitalization in
August 2002. The varicella incubation period was 10 days, which matched the range
(10-21 days). Recently negative specific serum IgM and positive specific serum
IgG indicated a past VZV infection. The nurse did not get herpes zoster from the
second episode of varicella on 9 August 2002 to 4 April 2005 and is now
convalescing. We conclude that occupational VZV hazards exist in the health care
environment and suggest testing for VZV antibody and a VZV vaccination program
for susceptible health care workers. Key words: chickenpox, indirect fluroscent
antibody, occupational exposure, polymerase chain reaction, shingles, Taiwan,
varicella-zoster virus.
Publication Types:
Case Reports
PMID: 16203249 [PubMed - indexed for MEDLINE]
118: Am Fam Physician. 2005 Sep 15;72(6):1082.
Information from your family doctor. Shingles: easing the pain.
American Academy of Family Physicians.
Publication Types:
Patient Education Handout
PMID: 16190506 [PubMed - indexed for MEDLINE]
119: Health News. 2005 Aug;11(8):2.
Shingles vaccine proves highly effective.
[No authors listed]
Publication Types:
News
PMID: 16184636 [PubMed - indexed for MEDLINE]
120: 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.
Publication Types:
Clinical Trial
PMID: 16173526 [PubMed - indexed for MEDLINE]
121: 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]
122: 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.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review
PMID: 16098235 [PubMed - indexed for MEDLINE]
123: 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.
Publication Types:
Case Reports
PMID: 16054735 [PubMed - indexed for MEDLINE]
124: Physiol Biochem Zool. 2005 Sep-Oct;78(5):744-55. Epub 2005 Jul 28.
Reflex cardioventilatory responses to hypoxia in the flathead gray mullet (Mugil
cephalus) and their behavioral modulation by perceived threat of predation and
water turbidity.
Shingles A, McKenzie DJ, Claireaux G, Domenici P.
International Marine Centre, LocalitГ Sa Mardini, 09072 Torregrande (Or), Italy.
alexandrashingles@yahoo.co.uk
In hypoxia, gray mullet surface to ventilate well-oxygenated water in contact
with air, an adaptive response known as aquatic surface respiration (ASR). Reflex
control of ASR and its behavioral modulation by perceived threat of aerial
predation and turbid water were studied on mullet in a partly sheltered aquarium
with free surface access. Injections of sodium cyanide (NaCN) into either the
bloodstream (internal) or ventilatory water stream (external) revealed that ASR,
hypoxic bradycardia, and branchial hyperventilation were stimulated by
chemoreceptors sensitive to both systemic and water O2 levels. Sight of a model
avian predator elicited bradycardia and hypoventilation, a fear response that
inhibited reflex hyperventilation following external NaCN. The time lag to
initiation of ASR following NaCN increased, but response intensity (number of
events, time at the surface) was unchanged. Mullet, however, modified their
behavior to surface under shelter or near the aquarium edges. Turbid water
abolished the fear response and effects of the predator on gill ventilation and
timing of ASR following external NaCN, presumably because of reduced visibility.
However, in turbidity, mullet consistently performed ASR under shelter or near
the aquarium edges. These adaptive modulations of ASR behavior would allow mullet
to retain advantages of the chemoreflex when threatened by avian predators or
when unable to perceive potential threats in turbidity.
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 16052452 [PubMed - indexed for MEDLINE]
125: 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.
Publication Types:
Case Reports
PMID: 16008607 [PubMed - indexed for MEDLINE]
126: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 16006497 [PubMed - indexed for MEDLINE]
127: Time. 2005 Jun 13;165(24):67.
A shingles vaccine.
Gorman C.
Publication Types:
News
PMID: 15974024 [PubMed - indexed for MEDLINE]
128: 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]
129: 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.
Publication Types:
Case Reports
PMID: 15950335 [PubMed - indexed for MEDLINE]
130: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 15943957 [PubMed - indexed for MEDLINE]
131: N Engl J Med. 2005 Jun 2;352(22):2271-84.
Comment in:
ACP J Club. 2005 Nov-Dec;143(3):61. N Engl J Med. 2005 Jun 2;352(22):2266-7. N Engl J Med. 2005 Jun 2;352(22):2344-6. N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5. N Engl J Med. 2005 Sep 29;353(13):1414-5; author reply 1414-5. N Engl J Med. 2007 Jul 5;357(1):89. Nat Clin Pract Neurol. 2005 Nov;1(1):18-9.
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
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.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 15930418 [PubMed - indexed for MEDLINE]
132: Cell Biol Educ. 2005 Summer;4(2):123-37.
Points of view: a survey of survey courses: are they effective?
Eisen A, Batzli JM, Becker D, Fambrough DM, Pearlman R, Shingles R, Brosnan R,
Ledbetter ML, Campbell AM.
Department of Biology, Emory University, Atlanta, GA 30322, USA.
PMID: 15917871 [PubMed - indexed for MEDLINE]
133: JAMA. 2005 May 25;293(20):2459-60.
When shingles wanes but pain does not: researchers target chronic postherpetic
neuralgia.
Hampton T.
Publication Types:
News
PMID: 15914732 [PubMed - indexed for MEDLINE]
134: 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.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
PMID: 15870157 [PubMed - indexed for MEDLINE]
135: Evid Based Complement Alternat Med. 2005 Mar;2(1):113-116.
Mind-Body, Ki (Qi) and the Skin: Commentary on Irwin's 'Shingles Immunity and
Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment'
Kobayashi H, Ishii M.
PMID: 15841287 [PubMed - as supplied by publisher]
136: Evid Based Complement Alternat Med. 2004 Dec;1(3):223-232. Epub 2004 Dec 1.
Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a
Behavioral Treatment.
Irwin M, Pike J, Oxman M.
Both the incidence and severity of herpes zoster (HZ) or shingles increase
markedly with increasing age in association with a decline in varicella zoster
virus (VZV)-specific immunity. Considerable evidence shows that behavioral
stressors, prevalent in older adults, correlate with impairments of cellular
immunity. Moreover, the presence of depressive symptoms in older adults is
associated with declines in VZV-responder cell frequency (VZV-RCF), an
immunological marker of shingles risk. In this review, we discuss recent findings
that administration of a relaxation response-based intervention, tai chi chih
(TCC), results in improvements in health functioning and immunity to VZV in older
adults as compared with a control group. TCC is a slow moving meditation
consisting of 20 separate standardized movements which can be readily used in
elderly and medically compromised individuals. TCC offers standardized training
and practice schedules, lending an important advantage over prior relaxation
response-based therapies. Focus on older adults at increased risk for HZ and
assay of VZV-specific immunity have implications for understanding the impact of
behavioral factors and a behavioral intervention on a clinically relevant
end-point and on the response of the immune system to infectious pathogens.
PMID: 15841255 [PubMed - as supplied by publisher]
137: J Virol. 2005 May;79(9):5315-25.
Array analysis of simian varicella virus gene transcription in productively
infected cells in tissue culture.
Deitch SB, Gilden DH, Wellish M, Smith J, Cohrs RJ, Mahalingam R.
Department of Neurology, Mail Stop B182, 4200 E. 9th Avenue, Denver, CO 80262,
USA.
Simian varicella virus (SVV) is a neurotropic alphaherpesvirus of monkeys that is
a model for varicella pathogenesis and latency. Like human varicella-zoster virus
(VZV), SVV causes chicken pox (varicella), becomes latent in ganglia along the
entire neuraxis, and reactivates to produce shingles (zoster). We developed
macroarrays to determine the extent of viral transcription from all 70 predicted
SVV open reading frames (ORFs) in infected cells in tissue culture. Cloned
fragments (200 to 400 bp) from the 5' and 3' ends of each ORF were PCR amplified,
quantitated, spotted onto nylon membranes, and fixed by UV cross-linking. Using a
cDNA probe prepared from poly(A)+ RNA extracted from SVV-infected Vero cells at
the height of the cytopathic effect (3 days after infection) and
chemiluminescence for detection, transcripts corresponding to all SVV ORFs were
identified. The abundance of each SVV transcript was compared with that
previously demonstrated for VZV in infected tissue culture cells.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
PMID: 15827146 [PubMed - indexed for MEDLINE]
138: Hybridoma (Larchmt). 2005 Feb;24(1):50-4.
A chimeric antibody to varicella-zoster virus glycoprotein e.
Shankar V, Kools JJ, Armour KL, Clark MR.
Biologics Branch, Scientific Resources Program, Centers for Disease Control and
Prevention, Atlanta, Georgia 30333, USA. vbs2@cdc.gov
Varicella-Zoster virus (VZV) immune globulin (VZIG) derived from pooled human
serum is currently used in immunotherapy of VZV-associated complications of
chickenpox and shingles. We developed a mouse-human chimeric antibody against a
VZV glycoprotein E (gE) epitope as a safer replacement for VZIG. Variable (V)
heavy- and V kappa light-chain exons, derived from an anti-VZV gE antibody
secreting mouse hybridoma cell line, were cloned into expression vectors
containing an immunoglobulin promoter and enhancer, and human IgG1 or kappa
constant (C) region genes. The expression vectors were cotransfected into mouse
myeloma cell line (NSO), generating transformants that secreted chimeric
human-mouse IgGs. The chimeric and the parent mouse antibody were
indistinguishable in their antigen binding specificity. VZV gE chimeric antibody
may prove to be a prophylactic antibody that could provide significant advantages
over VZIG in having defined specificity, lessened possibility of contamination
with viral pathogens, and consistent availability.
Publication Types:
Comparative Study
PMID: 15785209 [PubMed - indexed for MEDLINE]
139: Antimicrob Agents Chemother. 2005 Mar;49(3):1081-6.
Susceptibilities of several clinical varicella-zoster virus (VZV) isolates and
drug-resistant VZV strains to bicyclic furano pyrimidine nucleosides.
Andrei G, Sienaert R, McGuigan C, De Clercq E, Balzarini J, Snoeck R.
Rega Institute for Medical Research, Minderbroedersstraat 10, B-3000 Leuven,
Belgium. graciela.andrei@rega.kuleuven.ac.be
Varicella-zoster virus (VZV) is responsible for primary infections as well as
reactivations after latency in the dorsal root ganglia. The treatment of such
infections is mandatory for immunocompromised patients and highly recommended for
elderly patients with herpes zoster infections (also called zona or shingles).
The treatment of choice is presently based on four molecules, acyclovir (ACV),
valaciclovir, famciclovir, and (in Europe) brivudine (BVDU). We present here our
data on the antiviral activity of a new class of potent and selective anti-VZV
compounds, bicylic pyrimidine nucleoside analogues (BCNAs), against a broad
variety of clinical isolates and different drug-resistant virus strains. The
results show that the BCNAs are far more potent inhibitors than ACV and BVDU
against clinical VZV isolates as well as the VZV reference strains Oka and YS.
The BCNAs were not active against ACV- and BVDU-resistant VZV strains bearing
mutations in the viral thymidine kinase gene but kept their inhibitory potential
against virus strains with mutations in the VZV DNA polymerase gene. Mutant virus
strains selected in the presence of the BCNAs were solely cross-resistant to
drugs, such as ACV and BVDU, that depend for their antiviral action on metabolic
activation by the viral thymidine kinase.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 15728906 [PubMed - indexed for MEDLINE]
140: Exp Mol Pathol. 2005 Apr;78(2):131-4. Epub 2005 Jan 5.
Symptomatic relief of herpetic skin lesions utilizing an energy-based approach to
healing.
Martin WJ, Stoneburner J.
Center for Complex Infectious Diseases, 3328 Stevens Avenue, Rosemead, CA 91770,
USA. s3support@email.com
Herpes simplex virus induced oral and genital ulcerating lesions will fluoresce
brightly yellow and yellow-orange, respectively, if treated with a chlorinated
solution of neutral red and exposed to ultraviolet-A light. An orange to red
fluorescence is seen with similarly treated and illuminated Herpes zoster virus
induced shingles; while treated human papillomavirus induced genital warts
display more of a purplish fluorescence. Pain and discomfort commonly disappear
soon after the treatment and all lesions undergo expedited healing that is
readily observable within 24 h. The mechanism of healing is thought to involve an
interaction between neutral red and alternative cellular energy pigments (ACE
pigments) present within the viral lesions that enhances responsiveness to
ultraviolet light energy. The healing effects are not restricted to the treated
lesions and may involve transmission of a biological energy throughout the body.
Beyond its obvious clinical and diagnostic utility, this model system may help
usher in a new era of energy-based medicine.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 15713438 [PubMed - indexed for MEDLINE]
141: 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]
142: 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.
Publication Types:
Review
PMID: 15653819 [PubMed - indexed for MEDLINE]
143: Curr Oncol Rep. 2005 Jan;7(1):66-73.
Leukemia and the nervous system.
Chamberlain MC.
Department of Neurology, University of Southern California, Norris Comprehensive
Cancer Center and Hospital, 1441 Eastlake Avenue, Room 3459, Los Angeles, CA
90033, USA. chamberl@usc.edu
Leukemia affects the central and peripheral nervous system. Neurologic
complications are a consequence of direct leukemic infiltration, as occurs with
leukemic meningitis, and due to complications of either antileukemic treatment
(thrombocytopenic or disseminated intravascular coagulation-related intracranial
hemorrhage, steroid myopathy, vinca alkaloid peripheral neuropathy) or immune
compromise (Herpes zoster shingles or Aspergillus meningitis).
Publication Types:
Review
PMID: 15610689 [PubMed - indexed for MEDLINE]
144: 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.
Publication Types:
Case Reports
PMID: 15561060 [PubMed - indexed for MEDLINE]
145: Cells Tissues Organs. 2004;178(1):48-59.
Changes in the epithelium of the vaginal complex during the estrous cycle of the
marsupial Monodelphis domestica. 2. Scanning electron microscopy study.
Kress A, Regli C, Spornitz UM, Morson G.
Institute of Anatomy, University of Basel, Basel, Switzerland.
annetrudi.kress@unibas.ch
The four stages of the estrous cycle in Monodelphis domestica, namely proestrus,
estrus, postestrus and the transitional metestrus, were analyzed with the
scanning electron microscope and compared with the results of the previously
published transmission electron-microscopic paper [Cells Tissues Organs
2002;172:276-296]. During the estrous cycle the vaginal epithelium undergoes
dramatic changes from a nonkeratinized to a highly keratinized epithelium. The
predominant feature of proestrus with the beginning of keratinization is the
presence of polygonal flat cells with pavement-like appearance, bordered by
raised ridges and covered with microvilli. The epithelium is fully keratinized in
estrus, and the superficial layers overlap like shingles. Many cells are still
densely covered by microvilli, whereas others develop a complex pattern of
microridges. In postestrus different epithelial structures are revealed depending
on the actual stage of desquamation. In early postestrus surface cells resemble
those present during estrus. In late postestrus, when only few keratinized cells
are left, the nonkeratinized cells become exposed to the lumen through
desquamation. These cells border the lumen during metestrus, a cycle stage during
which numerous leukocytes migrate into the vaginal canal. A number of these
uppermost cells is probably not yet prepared to function as metestrus cells and
are therefore sloughed off as well. During metestrus compact cell masses stick in
the vaginal furrows. Epithelial surface cells are highly irregular and bulging
with their microvilli covered surfaces in the vaginal lumen. This study
represents the first comprehensive description of alterations on the surface
ultrastructure of a marsupial vagina during the estrous cycle, demonstrating
considerable differences in comparison to many eutherians. 2004 S. Karger AG,
Basel.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 15550759 [PubMed - indexed for MEDLINE]
146: MMW Fortschr Med. 2004 Jul 22;146(29-30):60.
[Appearance diagnosis. Facial shingles]
[Article in German]
Mehling P.
Allgemeinmedizin, Höchberg.
Publication Types:
Case Reports
PMID: 15540566 [PubMed - indexed for MEDLINE]
147: J Environ Manage. 2004 Dec;73(4):307-15.
Roofing as a source of nonpoint water pollution.
Chang M, McBroom MW, Scott Beasley R.
Arthur Temple College of Forestry, Stephen F. Austin State University,
Nacogdoches, TX 75962, USA. mchang@sfasu.edu
Sixteen wooden structures with two roofs each were installed to study runoff
quality for four commonly used roofing materials (wood shingle, composition
shingle, painted aluminum, and galvanized iron) at Nacogdoches, Texas. Each roof,
either facing NW or SE, was 1.22 m wide x 3.66 m long with a 25.8% roof slope.
Thus, there were 32 alternatively arranged roofs, consisting of four roof types x
two aspects x four replicates, in the study. Runoff from the roofs was collected
through galvanized gutters, downspouts, and splitters. The roof runoff was
compared to rainwater collected by a wet/dry acid rain collector for the
concentrations of eight water quality variables, i.e. Cu(2+), Mn(2+), Pb(2+),
Zn(2+), Mg(2+), Al(3+), EC and pH. Based on 31 storms collected between October
1997 and December 1998, the results showed: (1) concentrations of pH, Cu, and Zn
in rainwater already exceed the EPA freshwater quality standards even without
pollutant inputs from roofs, (2) Zn and Cu, the two most serious pollutants in
roof runoff, exceeded the EPA national freshwater water quality standards in
virtually 100% and more than 60% of the samples, respectively, (3) pH, EC, and Zn
were the only three variables significantly affected by roofing materials, (4)
differences in Zn concentrations were significant among all roof types and
between all roof runoff and rainwater samples, (5) although there were no
differences in Cu concentrations among all roof types and between roof runoff and
rainwater, all means and medians of runoff and rainwater exceeded the national
water quality standards, (6) water quality from wood shingles was the worst among
the roof types studied, and (7) although SE is the most frequent and NW the least
frequent direction for incoming storms, only EC, Mg, Mn, and Zn in wood shingle
runoff from the SE were significantly higher than those from the NW; the two
aspects affected no other elements in runoff from the other three roof types.
Also, Zn concentrations from new wood-shingle roofs were significantly higher
than those from aged roofs of a previous study. The study demonstrated that roofs
could be a serious source of nonpoint water pollution. Since Zn is the most
serious water pollutant and wood shingle is the worst of the four roof types,
using less compounds and materials associated with Zn along with good care and
maintenance of roofs are critical in reducing Zn pollution in roof runoff.
PMID: 15531389 [PubMed - indexed for MEDLINE]
148: 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]
149: Rev Neurol (Paris). 2004 Oct;160(10):980-2.
[Facial palsy and central nervous system infection with varicella virus following
adult chickenpox]
[Article in French]
Nouh A, Landais A, Segondy M, Blard JM, PagГЁs M.
Service de Neurologie, Centre Gui de Chauliac, HГґpital Saint Eloi, CHU,
Montpellier.
INTRODUCTION: VZV virus-related peripheral neuropathies usually occur after
shingles in adults and more rarely after chickenpox in childhood. CASE REPORT: A
54-year-old patient presented with a right VIIth nerve palsy following a
chickenpox rash and recovered after antiviral treatment. CSF analysis revealed
lymphocytic meningitis and the virus was identified by PCR. CONCLUSIONS: Although
previous chickenpox was not found in the patient's past history, the probability
of reinfection is likely. The virus can be assumed to affect the nervous system
directly; the axonal or demyelinating mechanism of the neuropathy may be
discussed.
Publication Types:
Case Reports
English Abstract
PMID: 15492726 [PubMed - indexed for MEDLINE]
150: J Virol. 2004 Nov;78(21):11833-40.
The varicella-zoster virus open reading frame 63 latency-associated protein is
critical for establishment of latency.
Cohen JI, Cox E, Pesnicak L, Srinivas S, Krogmann T.
Medical Virology Section, Laboratory of Clinical Infectious Diseases, Bldg. 10,
Room 11N228, National Institutes of Health, 10 Center Dr., Bethesda, MD 20892,
USA. jcohen@niaid.nih.gov.
Varicella-zoster virus (VZV) expresses at least six viral transcripts during
latency. One of these transcripts, derived from open reading frame 63 (ORF63), is
one of the most abundant viral RNAs expressed during latency. The VZV ORF63
protein has been detected in human and experimentally infected rodent ganglia by
several laboratories. We have deleted >90% of both copies of the ORF63 gene from
the VZV genome. Animals inoculated with the ORF63 mutant virus had lower mean
copy numbers of latent VZV genomes in the dorsal root ganglia 5 to 6 weeks after
infection than animals inoculated with parental or rescued virus, and the
frequency of latently infected animals was significantly lower in animals
infected with the ORF63 mutant virus than in animals inoculated with parental or
rescued virus. In contrast, the frequency of animals latently infected with viral
mutants in other genes that are equally or more impaired for replication in
vitro, compared with the ORF63 mutant, is similar to that of animals latently
infected with parental VZV. Examination of dorsal root ganglia 3 days after
infection showed high levels of VZV DNA in animals infected with either ORF63
mutant or parental virus; however, by days 6 and 10 after infection, the level of
viral DNA in animals infected with the ORF63 mutant was significantly lower than
that in animals infected with parental virus. Thus, ORF63 is not required for VZV
to enter ganglia but is the first VZV gene shown to be critical for establishment
of latency. Since the present vaccine can reactivate and cause shingles, a VZV
vaccine based on the ORF63 mutant virus might be safer.
PMID: 15479825 [PubMed - indexed for MEDLINE]
151: Med Res Rev. 2005 Jan;25(1):1-20.
(E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU).
De Clercq E.
Department of Microbiology and Immunology, Division of Virology and Chemotherapy,
Rega Institute for Medical Research, Katholieke Universiteit Leuven, B-3000
Leuven, Belgium. erik.declercq@rega.kuleuven.ac.be
(E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU, Brivudin, Zostex, Zerpex, Zonavir),
now more than 20 years after its discovery, still stands out as a highly potent
and selective inhibitor of herpes simplex virus type 1 (HSV-1) and
varicella-zoster virus (VZV) infections. It has been used in the topical
treatment of herpetic keratitis and recurrent herpes labialis and the systemic
(oral) treatment of herpes zoster (zona, shingles). The high selectivity of BVDU
towards HSV-1 and VZV depends primarily on a specific phosphorylation of BVDU to
its 5'-diphosphate (DP) by the virus-encoded thymidine kinase (TK). After further
phosphorylation (by cellular enzymes), to the 5'-triphosphate (TP), the compound
interferes as a competitive inhibitor/alternate substrate with the viral DNA
polymerase. The specific phosphorylation by the HSV- and VZV-induced TK also
explains the marked cytostatic activity of BVDU against tumor cells that have
been transduced by the viral TK genes. This finding offers considerable potential
in a combined gene therapy/chemotherapy approach for cancer. To the extent that
BVDU or its analogues (i.e., BVaraU) are degraded (by thymidine phosphorylase) to
(E)-5-(2-bromovinyl)uracil (BVU), they may potentiate the anticancer potency, as
well as toxicity, of 5-fluorouracil. This ensues from the direct inactivating
effect of BVU on dihydropyrimidine dehydrogenase, the enzyme that initiates the
degradative pathway of 5-fluorouracil. The prime determinant in the unique
behavior of BVDU is its (E)-5-(2-bromovinyl) substituent. Numerous BVDU analogues
have been described that, when equipped with this particular pharmacophore,
demonstrate an activity spectrum characteristic of BVDU, including selective
anti-VZV activity. 2004 Wiley Periodicals, Inc.
Publication Types:
Review
PMID: 15389733 [PubMed - indexed for MEDLINE]
152: 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.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 15386593 [PubMed - indexed for MEDLINE]
153: 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.
PMID: 15383443 [PubMed - indexed for MEDLINE]
154: Agri. 2004 Jul;16(3):17-24.
Comment in:
Agri. 2004 Oct;16(4):64.
[Postherpetic neuralgia]
[Article in Turkish]
Cevik IU.
Harvard Medical School, Massachusetts General Hospital, Pain Center, Boston, MA
02114, USA. icevik@partners.org
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.
Publication Types:
English Abstract
Review
PMID: 15382001 [PubMed - indexed for MEDLINE]
155: J Pediatr Gastroenterol Nutr. 2004 Sep;39(3):265-9.
Safety of infliximab treatment in pediatric patients with inflammatory bowel
disease.
Friesen CA, Calabro C, Christenson K, Carpenter E, Welchert E, Daniel JF, Haslag
S, Roberts CC.
Section of Gastroenterology, The Children's Mercy Hospital and Clinics, Kansas
City, Missouri 64108, USA. cfriesen@cmh.edu
BACKGROUND: Infliximab appears to be efficacious in the treatment of pediatric
Crohn disease (CD). There are few large-scale pediatric studies on the
complications of infliximab therapy. METHODS: A retrospective review of all
infliximab infusions administered to IBD patients at a tertiary children's
hospital was undertaken. Data was obtained from an infliximab infusion database
maintained in the section of Pediatric Gastroenterology, pharmacy records and
patient charts. RESULTS: 594 infusions were administered to 111 IBD patients (88
CD and 23 UC; 55 male and 56 female; ages 4 to 20 years; mean age, 13.4 years).
The number of infusions ranged from 1 to 24 with a mean of 5.4/patient. Infusion
reactions occurred in 8.1% of patients (seven early and two delayed) and in 1.5%
of all infusions. Reactions occurred more frequently in female patients (14%
versus 2%; P = 0.03). All reactions were mild and responded rapidly to treatment.
Four patients had infections deemed unusual, including three cutaneous tinea
infections and one case of shingles. CONCLUSION: Infliximab is safe in pediatric
IBD patients with a low incidence of generally mild reactions that respond
rapidly to intervention. Infusion reactions are more common in female patients.
Our patients had no serious infectious complications, although cutaneous tinea
infection may represent a newly reported associated complication.
PMID: 15319627 [PubMed - indexed for MEDLINE]
156: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 15307000 [PubMed - indexed for MEDLINE]
157: Health News. 2004 Jul;10(7):9.
Older women face higher risk of post-shingles pain.
[No authors listed]
Publication Types:
News
PMID: 15239158 [PubMed - indexed for MEDLINE]
158: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 15221911 [PubMed - indexed for MEDLINE]
159: J Drug Target. 2003 Aug;11(7):433-41.
Targeted dermal delivery of highly potent anti-varicella zoster virus nucleoside
analogues from saturated solutions and ethanolic oil-in-water creams.
Jarvis CA, Heard CM, McGuigan C.
Welsh School of Pharmacy, Cardiff University, Cardiff CF10 3XF, UK.
Varicella zoster virus (VZV) is responsible for causing chickenpox and shingles
infections, the latter of which can lead to long-term post-herpetic neuralgia
(PHN), the most common complication of VZV infections. A class of anti-VZV
nucleoside analogues has been synthesised that shows up to 30,000 times the
potency of aciclovir in vitro. The relatively high lipophilicities exhibited by
the compounds led them to be selected for dermal delivery. The aim was to assess
the relative penetration and permeation of the compounds into and through the
skin, ideally targeting the region of skin in which the reactivated virus
replicates. By targeting the skin it should be possible to reduce the viral load
that causes damage to the nerves, thereby limiting zoster-associated pain, in
particular PHN. Three compounds, as saturated solutions or as ethanol-based
creams, were applied to full-thickness pig ear skin in Franz-type diffusion
cells. An ethanolic and water receptor phases were compared. Samples of the
receptor phase were taken at specific intervals, followed by tape stripping and
separation of the remaining membrane at the end of the experiment. Analysis of
the samples showed that all three compounds penetrated into the ethanolic
receptor phase to a considerable degree, while only the least lipophilic compound
entered the water receptor phase. The effects of the organic solvent in the
receptor phase were visible in both the penetration and permeation of the
compounds. All three compounds were distributed throughout the membrane in a
manner that indicates that the site of viral replication in the skin is reached.
Publication Types:
In Vitro
Research Support, Non-U.S. Gov't
PMID: 15203932 [PubMed - indexed for MEDLINE]
160: 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]
161: Plant Physiol. 2004 May;135(1):145-51. Epub 2004 Apr 30.
Copper transport across pea thylakoid membranes.
Shingles R, Wimmers LE, McCarty RE.
Department of Biology, Johns Hopkins University, Baltimore, Maryland 21218-2685,
USA. shingles@jhu.edu
The initial rate of Cu2+ movement across the thylakoid membrane of pea (Pisum
sativum) chloroplasts was directly measured by stopped-flow spectrofluorometry
using membranes loaded with the Cu(2+)-sensitive fluorophore Phen Green SK. Cu2+
transport was rapid, reaching completion within 0.5 s. The initial rate of uptake
was dependent upon Cu2+ concentration and saturated at about 0.6 microm total
Cu2+. Cu2+ uptake was maximal at a thylakoid lumen pH of 7.0. Cu2+ transport was
inhibited by Zn2+ but was largely unaffected by Mn2+ and Cu+. Zn2+ inhibited Cu2+
transport to a maximum of 60%, indicating that there may be more than one
transporter for copper in pea thylakoid membranes.
PMID: 15122011 [PubMed - indexed for MEDLINE]
162: Pain Med. 2002 Dec;3(4):324-32.
Lidocaine patch 5% reduces pain intensity and interference with quality of life
in patients with postherpetic neuralgia: an effectiveness trial.
Katz NP, Gammaitoni AR, Davis MW, Dworkin RH; Lidoderm Patch Study Group.
Harvard Medical School, Boston, Massachusetts, USA. NatPaulKatz@aol.com
OBJECTIVE: To assess the effectiveness of the lidocaine patch 5% (Lidoderm), a
targeted peripheral analgesic, in reducing pain intensity/interference with
quality of life (QOL) among patients with postherpetic neuralgia (PHN). DESIGN:
Open-label, nonrandomized, effectiveness study; up to three patches applied to
area of greatest pain for 12 hours per day for 28 days. SETTING: Forty-two
centers consisting of large institutional primary care programs and academic
centers, including pain centers, neurologists, and pain specialists affiliated
with a university. PATIENTS: Patients with PHN (N = 332). OUTCOME MEASURES:
Patients completed the Brief Pain Inventory Short Form and global pain
assessments at baseline, Days 7 and 14, and study conclusion. Physicians
completed global assessments at baseline and study conclusion. RESULTS: The mean
time from onset of herpes zoster to treatment was 28 months. Use of the lidocaine
patch 5% was associated with reductions in all mean pain intensity, pain
interference with QOL, and composite scores at all time points (P = 0.0001).
Overall, 66% of patients reported improvement in pain intensity, and 74% reported
improved QOL by Day 7; approximately 43% who did not respond by Day 7 experienced
improvement in pain intensity by Day 14. For all measures of pain intensity,
relief, and interference with QOL, improvements from baseline were equally
significant regardless of time since shingles onset. In all, approximately 60% of
patients reported moderate to complete pain relief at final evaluation. The
lidocaine patch 5% was well tolerated. CONCLUSIONS: Based on results of previous
randomized, controlled trials and the current study, designed to gauge response
in the clinical practice setting, the lidocaine patch 5% should be considered a
first-line therapy, alone or in combination with other agents, for PHN due to its
efficacy, safety, minimal systemic side effects and drug interactions, and ease
of administration. Although the lidocaine patch 5% was equally effective in
longstanding PHN, it would appear prudent to begin therapy as early in the course
of PHN as possible.
PMID: 15099237 [PubMed]
163: J Long Term Eff Med Implants. 2004;14(2):131-64.
Prevention of residential roof fires by use of a class "A" fire rated roof
system.
Edlich RF, Winters KL, Long WB, Britt LD.
University of Virginia Health System, Charlottesville, Virginia, USA.
Because residential roof fires remain a life-threatening danger to residential
homeowners in the United States, we describe in detail a national fire prevention
program for reducing residential roof fires by use of an Underwriters
Laboratories Inc. (UL) and National Fire Protection Association Class A fire
rated roof system. This Class A system should comply with the test requirements
for fire resistance of roof coverings, as outlined in UL 790 or in ASTM
International (ASTM) E-108. Both the Asphalt Roofing Manufacturer's Association
(ARMA) and the National Roofing Contractors Association (NRCA) have set up
guidelines for selecting a new roof for the homeowner. Class A, fiber-glass-based
asphalt roofing shingles represent an overwhelming share of the United States
residential roofing market, and, as such, the Class A rated roofing system
remains an excellent alternative to wood shingles and shakes. Fortunately, the
Class A fire rating is available for certain wood shingle products that
incorporate a factory-applied, fire resistant treatment. However, in this
circumstance, wood products labeled as Class B shakes or shingles must be
installed over spaced or solid sheathing that have been covered either with one
layer of 1/4 in. (6.4 mm) thick noncombustible roof board, or with one layer of
minimum 72-lb. fiber-glass-based mineral surfaced cap sheet, or with another
specialty roofing sheet to obtain the Class A fire rating. Clay, tile, slate, and
metal have been assigned Class A fire ratings in the codes (but often without
testing). These alternative roofing materials are often considerably more
expensive. Proper application, ventilation, and insulation of roofing systems are
required to prevent heat and moisture buildup in the attic, which can damage the
roofing system, making it more susceptible to water leakage as well as ignition
in the event of a fire. The NRCA has devised excellent recommendations for the
homeowner to prequalify the contractor. In addition, a warranty for any new
roofing material is important for the homeowner to ensure that the roofing can be
repaired by the contractor or manufacturer during the specified warranty period,
in case of contractor error or a manufacturing defect. In addition, the homeowner
should ensure that the warranty is transferable to any future owner of the home
to allow the buyer to have the same warranty benefits as the original owner. The
State of California has mandated strict roofing requirements to prevent
residential fires. In the absence of this legislation in other states, the
homeowner must follow the guidelines outlined in this collective review to ensure
that a roofing system with Class A fire protection is installed. Other fire
safety precautions that should also be considered mandatory are to include smoke
alarms, escape plans, and retrofit fire sprinklers.
PMID: 15099189 [PubMed - indexed for MEDLINE]
164: 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
Publication Types:
Review
PMID: 15095537 [PubMed - indexed for MEDLINE]
165: 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.
Publication Types:
Case Reports
Comparative Study
Review
PMID: 15061819 [PubMed - indexed for MEDLINE]
166: 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.
Publication Types:
Case Reports
English Abstract
Review
PMID: 15041920 [PubMed - indexed for MEDLINE]
167: 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.
Publication Types:
Review
PMID: 15013924 [PubMed - indexed for MEDLINE]
168: Acupunct Electrother Res. 2003;28(3-4):183-92.
Does a viral infection cause complex regional pain syndrome?
Muneshige H, Toda K, Kimura H, Asou T.
Department of Rehabilitation, Hiroshima University Hospital, 1-2-3 Kasumi,
Minami-ku, Hiroshima, Japan 734-8551.
In 1990 Omura, Y. reported that Herpes Simplex Virus Type 1 as the major cause of
chronic intractable pain and its effective treatment using mixture of EPA & DHA
with Selective Drug Uptake Enhancement Method. Subsequently among the other
causes of pain, he included Chlamydia Trachomatis, Borrelia Burgdorferi,
Mycobacterium Tuberculosis, human Herpes Virus type 6, and Circulatory
Disturbances. In order to test possible involvement of viral infection in Complex
Regional Pain Syndrome (CRPS), a disease which usually occurs in the extremities,
we did a study of 17 patients with CRPS. They were examined for Herpes Simplex
Virus (HSV) and Varicella Zoster Virus (VZV) by measuring IgG and IgM antibody
titers, and 14 of these patients were also examined for Cytomegalo-Virus (CMV).
As a control group 100 healthy Japanese employees at SRL, Inc. were also studied.
In CRPS group, HSV IgG was positive in 12 of the 17 patients with an average
antibody titer of 90.0 EIA value. VZV IgG was positive in all 17 patients with an
average antibody titer of 26.8 EIA value. CMV IgG was positive in all 14 patients
with an average antibody titer of 66.6 UA/ml. In control group, HSV IgG was
positive in 54 subjects with an average antibody titer of 42.3 EIA value. VZV IgG
was positive in 97 subjects with an average antibody titer of 26.2 EIA value. CMV
IgG was positive in 82 subjects. There were no significant differences of
positive rate of IgG antibody for the three viruses between patient and control
groups. Although the difference was not significant, the average antibody titers
of HSV in CRPS group were more than twice of those in healthy group. Antibody
titers were almost equal in both groups for VZV. Possibly, some people in the
control group who had latent virus, were also asymptomatic. In 2000, Takasaki, I.
et al. in a separate animal study, inoculated with HSV Type-I the shin of the
mouse causing allodynia and hyperalgesia (which are some of the characteristic
findings seen in CRPS in humans). Also, VZV, which causes shingles which is
sometimes followed by Post-Herpetic Neuralgia (PHN), is in the same family of
HSV. As PHN resembles CRPS in symptoms, it is possible that HSV contributes to
CRPS. Therefore, virus infection theory is an attractive hypothesis that accounts
for many enigmas of CRPS.
Publication Types:
Clinical Trial
Comparative Study
PMID: 14998056 [PubMed - indexed for MEDLINE]
169: 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%).
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 14979582 [PubMed - indexed for MEDLINE]
170: Pediatr Dermatol. 2004 Jan-Feb;21(1):18-23.
Revisiting childhood herpes zoster.
Nikkels AF, Nikkels-Tassoudji N, PiГ©rard GE.
Department of Dermatopathology, University Medical Center of LiГЁge, LiГЁge,
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]
171: Front Biosci. 2004 Jan 1;9:751-62.
Varicella zoster virus latency, neurological disease and experimental models: an
update.
Cohrs RJ, Gilden DH, Mahalingam R.
Department of Neurology, University of Colorado Health Sciences Center, Denver,
CO 80262, USA.
Varicella zoster virus (VZV), a ubiquitous neurotropic human herpesvirus, causes
chickenpox (varicella) and then remains latent for decades in cranial nerve,
dorsal root and autonomic nervous system ganglia along the entire neuraxis. Virus
reactivation, most often after age 60, produces shingles (zoster), characterized
by pain and rash usually restricted to 1-3 dermatomes. In elderly individuals,
zoster is frequently complicated by postherpetic neuralgia (PHN), pain that
persists for months to years after the resolution of rash. Virus may also spread
beyond ganglia to the spinal cord to cause myelitis, as well as to blood vessels
of the brain, producing a unifocal or multifocal vasculopathy. The increased
incidence of zoster in the elderly and immunocompromised individuals appears to
be due to a VZV-specific host immunodeficiency. Recent studies indicate that PHN
may be due to a chronic active VZV ganglionitis, and that VZV vasculopathy is
caused by a productive virus infection in cerebral arteries. Since neurological
disease produced by VZV is due to reactivation from ganglia, the physical state
of viral nucleic acid and expression during latency as well as the possible
mechanisms by which VZV latency is maintained and reactivates are discussed.
Finally, VZV is an exclusively human herpesvirus, and experimental infection of
animals with VZV does not produce disease nor does VZV reactivate from ganglia.
Two varicella models in primates have proven useful: one that mimics varicella
latency in humans, and one that can be used to study the efficacy of antiviral
agent in driving varicella virus back to a latent state.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 14766405 [PubMed - indexed for MEDLINE]
172: Curr Opin Pediatr. 2004 Feb;16(1):80-4.
Varicella zoster virus infections in children after the introduction of live
attenuated varicella vaccine.
VГЎzquez M.
Department of Pediatrics, Yale University School of Medicine, New Haven,
Connecticut 06520-8064, USA. Marietta.Vazquez@yale.edu
PURPOSE OF REVIEW: Varicella zoster virus is the cause of both varicella
(chickenpox) and herpes zoster (shingles). A live attenuated varicella vaccine
was developed in 1974 and was approved in 1995 by the United States Food and Drug
Administration for administration to both healthy children (>12 months of age)
and adults who are susceptible to varicella. Many studies have shown varicella
vaccine to be highly effective. Widespread use of the varicella vaccine in the
United States has led to important changes in the epidemiology of the infection.
The purpose of this review is to summarize the most recent and important findings
regarding the impact that the widespread use of varicella vaccine has had on the
epidemiology of varicella zoster infections in children. RECENT FINDINGS: Data
from the United States Centers for Disease Control and Prevention have shown a
dramatic decline in the incidence of varicella (76 to 87% from 1995 to 2000),
with the greatest decline observed in preschool children, as well as a reduction
in the number of hospitalizations for cases of varicella. However, as the
proportion of children in the United States who have received the varicella
vaccine has increased there have been several recent reports in which the
effectiveness of the vaccine was substantially lower than expected. In
particular, reports during outbreaks of varicella in children have noted
increases in breakthrough disease in children who were vaccinated before the age
of 15 months, in children with asthma, in those who received the varicella
vaccine soon after the measles, mumps, and rubella vaccine (<28 days), and in
children who received the vaccine more than 3 years before the development of
disease. SUMMARY: Although reports of outbreaks of chickenpox in highly immunized
groups have raised questions regarding the need for changes to the current
vaccination policy, data undeniably indicate that immunization with varicella
vaccine has been and continues to be successful in reducing the burden of disease
in children and that universal immunization should continue to be a priority in
the United States
Publication Types:
Review
PMID: 14758119 [PubMed - indexed for MEDLINE]
173: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 14760796 [PubMed - indexed for MEDLINE]
174: 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.
Publication Types:
In Vitro
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 14719363 [PubMed - indexed for MEDLINE]
175: 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=14 days before the index date. Persons who were not continuously
eligible for medical and drug benefits for 6 months before and after the index
date (pretreatment and follow-up, respectively) were dropped from the study
sample. Use of opioids, including both short- and long-acting formulations, was
compared between pretreatment and follow-up. Patients were stratified in the
study analyses by whether they received 1 or >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]
176: Prof Nurse. 2003 Dec;19(4):195-6.
Varicella-zoster virus, shingles and postherpetic neuralgia.
Shuttleworth A.
Publication Types:
Review
PMID: 14692251 [PubMed - indexed for MEDLINE]
177: Arch Pediatr. 2003 Dec;10(12):1113-8.
[Chickenpox during pregnancy]
[Article in French]
Mirlesse V, Lebon P.
Centre de diagnostique prГ©natal et de mГ©decine foetale, institut de puГ©riculture,
Paris, France. mirlesse.v@free.fr
Varicella during pregnancy is a rare occurrence because of a high rate of
spontaneous immunisation in the population. When a pregnant woman presents a
typical rash, maternal complications, mainly respiratory distress, can occur and
be life threatening. Fetal complications include two types of consequences.
Before 24 weeks of gestation, transplacental transmission is estimated around 6%,
with about one third of infected fetuses presenting clinical manifestations.
Congenital varicella syndrome includes growth retardation, neurological effects
as microcephaly, limbs malposition, lung or bowel hyperechogenicity. But most
infected fetuses will not show any anomaly. A very few might develop shingles in
the first year of life. Peripartum contamination brings a much higher risk of
transmission (around 25%). Neonatal varicella infection can be life threatening
for the new born baby, especially if premature. A specific treatment should be
started as soon as the contamination is discovered. Zoster during pregnancy does
not lead to a risk of fetal infection.
Publication Types:
English Abstract
Review
PMID: 14643554 [PubMed - indexed for MEDLINE]
178: Bull Mem Acad R Med Belg. 2003;158(3-4):169-73; discussion 174-5.
[Mysteries of viral latency and reactivation]
[Article in French]
Rentier B.
Varicella-zoster virus is a Herpesvirus responsible for three distinct clinical
features: chicken pox (varicella), shingles (herpes zoster) and post-zosterian
pain (post-herpetic neuralgia). Neurological features of these diseases such as
complications of chicken pox, viral latency in sensory ganglia and reactivation
as shingles with concurrent and possibly subsequent prolonged pain, are the
sequels of the invasion of the peripheral nervous system during primary
infection. Prevention is achieved by vaccination with a live attenuated virus
strain and therapy calls for specific antiviral agents. In many respects, vzv
behaves differently from close relatives. In particular, viral latency in the
nervous system is basically different from that of other Herpesviridae. The
recent discovery of the expression of some viral regulatory proteins during
latency, although it had always been considered that vzv latency was silent, and
demonstration that these proteins are immunogenic open new avenues concerning the
immune control of vzv reactivation.
Publication Types:
English Abstract
PMID: 14639872 [PubMed - indexed for MEDLINE]
179: Mayo Clin Womens Healthsource. 2001 May;5(5):6.
Shingles.
[No authors listed]
PMID: 14639308 [PubMed - in process]
180: J Am Pharm Assoc (2003). 2003 Sep-Oct;43(5 Suppl 1):S22-3.
New options in herpes management.
Knodel L, Goad J.
University of Texas Health Sciences Center at San Antonio, USA.
Herpesviruses in the alpha group--HSV-1, HSV-2, and VZV (i.e., HSV-3)--are
ubiquitous in American society. HSV-1 is associated primarily with herpes
labialis, while HSV-2 is involved in about 70% of cases of genital herpes.
Varicellazoster virus causes chickenpox in unvaccinated children and others, and
latent virus produces shingles later in life. Since many patients with HSV-1 and
HSV-2 infections are asymptomatic, testing is important in determining presence
of the viruses. Several antiviral agents effective against HSV have been
marketed. While the infection cannot be cured, the available medications are
effective for reducing the duration of outbreaks, recurrences, and possibly viral
transmission.
Publication Types:
Congresses
PMID: 14626519 [PubMed - indexed for MEDLINE]
181: 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.
Publication Types:
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 14622691 [PubMed - indexed for MEDLINE]
182: Br J Gen Pract. 2003 Oct;53(495):778-83.
Comment in:
Br J Gen Pract. 2004 Feb;54(499):132; author reply 132-3.
The reducing incidence of respiratory tract infection and its relation to
antibiotic prescribing.
Fleming DM, Ross AM, Cross KW, Kendall H.
Birmingham Research Unit, Royal College of General Practitioners, 54 Lordswood
Road, Harborne, Birmingham B17 9DB. dfleming@rcgpbhamresunit.nhs.uk
BACKGROUND: There is good evidence of reduced prescribing of antibiotics in
recent years, but the reason for this has not been established. AIM: To study the
incidence of respiratory tract infections presenting to general practitioners
(GPs) in England and Wales in relation to the incidence of other infections and
to the prescription of antibiotics. SETTING: Sentinel practices in England and
Wales who contribute to the Weekly Returns Service (WRS) of the Royal College of
General Practitioners. DESIGN: Time-series analysis of disease incidence data
reported by the practices and of antibiotic prescription data from the
Prescription Pricing Authority (PPA) during the years 1994-2000. METHOD:
Incidence data reported weekly from 73 practices in England and Wales, serving a
population of 600,000, for acute respiratory tract infections, otitis media,
infectious mononucleosis, shingles, urinary tract infections, and skin
infections, were consolidated into quarterly datasets and examined graphically
for evidence of secular and seasonal trends. Trends in antibiotic prescription
items (data for England only were supplied by the PPA) were examined for
association after adjustment for seasonal variation. RESULTS: The incidence of
respiratory tract infections and antibiotic prescribing showed virtually
identical seasonal variation, with both declining from 1995: respiratory tract
infections by 48% in winter and 38% in summer, and antibiotic prescriptions by
34% and 21%, respectively. Trends in both were very highly correlated. The
incidence of shingles and skin infections was constant. The incidence of urinary
tract infections declined by 10%. The incidence of otitis media in children and
acute bronchitis in the elderly followed the all-age trend in the reduction of
respiratory tract infections. CONCLUSION: The considerable reduction in the
incidence of respiratory tract infections between 1995 and 2000 is the main
reason for the decline in antibiotic prescribing rather than changing prescribing
thresholds for antibiotics.
Publication Types:
Multicenter Study
Research Support, Non-U.S. Gov't
PMID: 14601353 [PubMed - indexed for MEDLINE]
183: Tidsskr Nor Laegeforen. 2003 Oct 23;123(20):2871-3.
[Meningitis associated with reactivation of varicella-zoster virus]
[Article in Norwegian]
MГёrch K, Fylkesnes SI, Haukenes G.
Avdeling for mikrobiologi og immunologi, Haukeland Universitetssykehus, Bergen.
kristine.moerch@helse-bergen.no
BACKGROUND: Reactivation of varicella-zostervirus (VZV) can manifest as infection
of the central nervous system. The detection of VZV DNA in cerebrospinal fluid by
polymerase chain reaction has extended our knowledge about the frequency of
various clinical manifestations in the immunocompetent host, also without the
typical rash of shingles. MATERIAL AND METHODS: Over a period of three years,
1999 through 2001, we performed VZV polymerase chain reaction in cerebrospinal
fluid in 364 patients with suspected infection of the central nervous system.
RESULTS: We detected VZV DNA in the cerebrospinal fluid in five patients. Four of
the patients had reactivated VZV infection. Meningitis was seen in two young
immunocompetent individuals; one of them without shingles. One patient had
myelitis without shingles and one had zoster radiculitis. One patient was a child
with encephalitis and primary infection. INTERPRETATION: Our results are similar
to results from other investigators that have found VZV DNA in the cerebrospinal
fluid in immunocompetent patients with meningitis or encephalitis as the most
common clinical manifestation, with or without shingles.
Publication Types:
Case Reports
English Abstract
PMID: 14600712 [PubMed - indexed for MEDLINE]
184: 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]
185: Viral Immunol. 2003;16(3):243-58.
Clinical and molecular pathogenesis of varicella virus infection.
Gilden DH, Cohrs RJ, Mahalingam R.
Department of Neurology, University of Colorado Health Sciences Center, Denver,
Colorado 80262, USA. don.gilden@uchsc.edu
Varicella zoster virus (VZV) is a neurotropic human herpesvirus that infects
nearly all humans and causes chickenpox (varicella). After chickenpox, VZV
becomes latent in cranial nerve, dorsal root, and autonomic nervous system
ganglia along the entire neuraxis. Virus reactivation produces shingles (zoster),
characterized by pain and rash usually restricted to 1-3 dermatomes. Zoster is
often complicated by postherpetic neuralgia (PHN), pain that persists for months
to years after rash resolves. Virus may also spread to the spinal cord and blood
vessels of the brain, producing a unifocal or multifocal vasculopathy,
particularly in immunocompromised individuals. The increased incidence of zoster
in elderly and immunocompromised individuals appears to be due to a VZV-specific
host immunodeficiency. PHN may reflect a chronic VZV ganglionitis, and VZV
vasculopathy is due to productive virus infection in cerebral arteries.
Strategies that might boost host cell-mediated immunity to VZV are discussed, as
well as the physical state of viral nucleic acid during latency and the possible
mechanisms by which herpesvirus latency is maintained and virus is reactivated. A
current summary of varicella latency and pathogenesis produced by simian
varicella virus (SVV), the counterpart of human VZV, points to the usefulness of
a primate model of natural infection to study varicella latency, as well as the
experimental model of intratracheal inoculation to study the effectiveness of
antiviral agents in driving persistent varicella virus into a latent state.
Publication Types:
Comparative Study
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 14583142 [PubMed - indexed for MEDLINE]
186: Neurosurgery. 2003 Nov;53(5):1164-6; discussion 1166-7.
A new classification for facial pain.
Burchiel KJ.
Department of Neurological Surgery, Oregon Health and Science University,
Portland, Oregon 97239, USA. burchiek@ohsu.edu
PURPOSE: A patient-oriented classification scheme for facial pains commonly
encountered in neurosurgical practice is proposed. CONCEPT: This classification
is driven principally by the patient's history. RATIONALE: The scheme
incorporates descriptions for so-called "atypical" trigeminal neuralgias and
facial pains but minimizes the pejorative, accepting that the physiology of
neuropathic pains could reasonably encompass a variety of pain sensations, both
episodic and constant. Seven diagnostic labels result: trigeminal neuralgia Types
1 and 2 refer to patients with the spontaneous onset of facial pain and either
predominant episodic or constant pain, respectively. Trigeminal neuropathic pain
results from unintentional injury to the trigeminal nerve from trauma or surgery,
whereas trigeminal deafferentation pain results from injury to the nerve by
peripheral nerve ablation, gangliolysis, or rhizotomy in an intentional attempt
to treat either trigeminal neuralgia or other facial pain. Postherpetic neuralgia
follows a cutaneous herpes zoster outbreak (shingles) in the trigeminal
distribution, and symptomatic trigeminal neuralgia results from multiple
sclerosis. The final category, atypical facial pain, is synonymous with facial
pain secondary to a somatoform pain disorder. Atypical facial pain can be
suspected but not diagnosed by history and can be diagnosed only with detailed
and objective psychological testing. CONCLUSION: This diagnostic classification
would allow more rigorous and objective natural history and outcome studies of
facial pain in the future.
Publication Types:
Review
PMID: 14580284 [PubMed - indexed for MEDLINE]
187: 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.
Publication Types:
Review
PMID: 14577953 [PubMed - indexed for MEDLINE]
188: J Virol. 2003 Nov;77(21):11718-32.
Array analysis of viral gene transcription during lytic infection of cells in
tissue culture with Varicella-Zoster virus.
Cohrs RJ, Hurley MP, Gilden DH.
Department of Neurology, University of Colorado Health Sciences Center, Denver,
Colorado 80262, USA. randall.cohrs@uchsc.edu
Varicella-zoster virus (VZV), a neurotropic alphaherpesvirus, causes childhood
chickenpox (varicella), becomes latent in dorsal root and autonomic ganglia, and
reactivates decades later to cause shingles (zoster) and other neurologic
complications. Although the sequence and configuration of VZV DNA have been
determined, relatively little is known about viral gene expression in
productively infected cells. This is in part because VZV is highly cell
associated, and sufficient titers of cell-free virus for use in synchronizing
infection do not develop. PCR-based transcriptional arrays were constructed to
simultaneously determine the relative abundance of the approximately 70 predicted
VZV open reading frames (ORFs). Fragments (250 to 600 bp) from the 5' and 3' end
of each ORF were PCR amplified and inserted into plasmid vectors. The virus DNA
inserts were amplified, quantitated, and spotted onto nylon membranes. Probing
the arrays with radiolabeled cDNA synthesized from VZV-infected cells revealed an
increase in the magnitude of the expressed VZV genes from days 1 to 3 after
low-multiplicity virus infection but little change in their relative abundance.
The most abundant VZV transcripts mapped to ORFs 9/9A, 64, 33/33A, and 49, of
which only ORF 9 corresponded to a previously identified structural gene. Array
analysis also mapped transcripts to three large intergenic regions previously
thought to be transcriptionally silent, results subsequently confirmed by
Northern blot and reverse transcription-PCR analysis. Array analysis provides a
formidable tool to analyze transcription of an important ubiquitous human
pathogen.
Publication Types:
Evaluation Studies
Research Support, U.S. Gov't, P.H.S.
PMID: 14557657 [PubMed - indexed for MEDLINE]
189: Public Health. 2003 Nov;117(6):446-51.
Pox in the docks: varicella outbreak in an Australian prison system.
Levy MH, Quilty S, Young LC, Hunt W, Matthews R, Robertson PW.
Corrections Health Service, Long Bay Prison Hospital, Matraville, NSW 2036,
Australia. levym@chs.health.nsw.gov.au
OBJECTIVES: 1. Describe an outbreak of varicella in a prison system. 2. Highlight
the risks of disease transmission within the prison environment. 3. Promote
infection control guidelines for high-risk sub-groups within the prison system,
including the application of quarantine. SETTING: Four prisons, one prison
hospital, the prison transport system, one courthouse. MAIN OUTCOME MEASURES:
Number of cases of varicella infection; reported varicella immunity status of
cases and contacts; immunity status of known HIV antibody positive inmates.
RESULTS: Five cases of chickenpox were identified. There were 23 contacts of the
Index Case occurring during transport between prison and court and whilst being
held in the court holding cells. Two of these contacts developed chickenpox
despite having given a prior history of infection. There were over 300 inmates
exposed to varicella zoster virus (VZV) during the outbreak, including one HIV
antibody positive inmate who had serologically confirmed immunity. This inmate
developed shingles following exposure to VZV from one of the cases. CONCLUSIONS:
There is an elevated risk of respiratory transmission of infections such as
chickenpox in prisons. Clear guidelines should be in place to protect HIV
antibody positive people, pregnant women, and others who are at increased risk of
complications from such infections. In the case of varicella, all inmates and
staff without documented immunity should be screened to determine immunity, and
if non-immune, should be offered VZV vaccination. Every effort should be made to
prevent HIV antibody positive inmates being exposed to varicella, regardless of
their varicella immunity status. If an HIV antibody positive inmate, who is known
to be non-immune is exposed to varicella, Varicella Zoster immunoglobulin should
be given within 96 h.
Publication Types:
Multicenter Study
PMID: 14522161 [PubMed - indexed for MEDLINE]
190: 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.
Publication Types:
Clinical Trial
Controlled Clinical Trial
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.
PMID: 14508027 [PubMed - indexed for MEDLINE]
191: Harv Health Lett. 2003 Sep;28(11):4-5.
Shingles: When a slumbering virus stirs.
[No authors listed]
PMID: 14505966 [PubMed - indexed for MEDLINE]
192: 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.
Publication Types:
Review
PMID: 12921490 [PubMed - indexed for MEDLINE]
193: J Occup Environ Med. 2003 Aug;45(8):857-68.
Exposure to animals and selected risk factors among Canadian farm residents with
Hodgkin's disease, multiple myeloma, or soft tissue sarcoma.
Pahwa P, McDuffie HH, Dosman JA, Robson D, McLaughlin JR, Spinelli JJ, Fincham S.
Institute of Agricultural Rural and Environmental Health, Saskatchewan Cancer
Agency, Saskatoon SK S7N 0W8, Canada.
Exposures to farm animals has been associated with certain rare cancers.
Simultaneously, using the same methodology and control group, we conducted a
six-province incident, population-based study of Hodgkin's disease (HD), multiple
myeloma (MM), and soft tissue sarcoma (STS). Farm residence or work was reported
by 38% (n = 119) of HD, 45% (n = 178) of MM, 43% (n = 156) of STS cases and 45%
(n = 673) of controls. We conducted conditional logistic regression analyses and
report odds ratios (OR(adj)) and 95% confidence intervals. After adjustment for
covariates, exposure to farm animals had minimal effect on risk. The independent
risk factors after adjustment for covariates were a family history of cancer (MM,
STS), occupational uranium exposure (HD), professional driving (MM), and personal
previous cancer (MM) or shingles (HD, MM).
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 12915787 [PubMed - indexed for MEDLINE]
194: Anticancer Res. 2003 May-Jun;23(3A):2063-9.
Varicella zoster virus transcription in latently-infected human ganglia.
Cohrs RJ, Gilden DH.
Department of Neurology, University of Colorado Health Sciences Center, 4200 E.
9th Avenue, Mail Stop B182, Denver, Colorado 80262, USA.
Varicella zoster virus (VZV) causes childhood chickenpox, becomes latent in
cranial, dorsal root and autonomic ganglia, and can reactivate decades later to
cause shingles and other serious neurological complications. Herein, we summarize
investigations conducted over the past decade that have identified virus genes
expressed in latently-infected human ganglia. A model of VZV gene regulation
during latent infection was tested and future directions in the study of VZV
latency are discussed.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 12894579 [PubMed - indexed for MEDLINE]
195: Comp Biochem Physiol A Mol Integr Physiol. 2003 Aug;135(4):515-26.
Sub-lethal plasma ammonia accumulation and the exercise performance of salmonids.
McKenzie DJ, Shingles A, Taylor EW.
School of Biosciences, University of Birmingham, Birmingham, B15 2TT, UK.
david.mckenzie@ifremer.fr
The proposal that plasma ammonia accumulation might impair the swimming
performance of fish was first made over a decade ago, and has now proven to be
the case for a number of salmonid species. The first experimental evidence was
indirect, when a negative linear relationship between plasma ammonia
concentrations and maximum sustainable swimming speed (U(crit)) was found
following the exposure of brown trout (Salmo trutta) to sub-lethal concentrations
of copper in soft acidic water. Since then, negative linear relationships between
plasma ammonia concentration and U(crit) have been demonstrated following
exposure of brown trout, rainbow trout (Oncorhynchus mykiss) and coho salmon
(Oncorhynchus kisutch) to elevated water ammonia. For brown trout, the
relationships between plasma ammonia and U(crit) were remarkably similar
following either exposure to elevated water ammonia or to sub-lethal copper. This
indicates that the impairment of swimming performance resulting from exposure to
sub-lethal concentrations of heavy metals may be attributable in large part to an
accumulation of endogenous ammonia. The negative relationship between plasma
ammonia concentration and U(crit) was similar in size-matched rainbow and brown
trout but, under similar regimes of ammonia exposure, rainbow trout were able to
maintain a significantly lower plasma ammonia concentration, revealing
inter-specific differences in ammonia permeability and/or transport. One primary
mechanism by which ammonia accumulation may impair exercise performance is a
partial depolarisation of membrane potential in tissues such as the brain and
white muscle. This may prejudice the co-ordination of swimming movements and
reduce or abolish the development of muscle tension, thus, compromising swimming
efficiency and performance at the top end of the range.
Publication Types:
Review
PMID: 12890542 [PubMed - indexed for MEDLINE]
196: Trans R Soc Trop Med Hyg. 2003 Jan-Feb;97(1):91-6.
Prevalence and indicators of HIV and AIDS among adults admitted to medical and
surgical wards in Blantyre, Malawi.
Lewis DK, Callaghan M, Phiri K, Chipwete J, Kublin JG, Borgstein E, Zijlstra EE.
Department of Medicine, University of Malawi College of Medicine, Private Bag
360, Chichiri, Blantyre 3, Malawi.
Despite high seroprevalence there are few recent studies of the effect of human
immunodeficiency virus (HIV) on hospitals in sub-Saharan Africa. We examined 1226
consecutive patients admitted to medical and surgical wards in Blantyre, Malawi
during two 2-week periods in October 1999 and January 2000: 70% of medical
patients were HIV-positive and 45% had acquired immune deficiency syndrome
(AIDS); 36% of surgical patients were HIV-positive and 8% had AIDS.
Seroprevalence rose to a peak among 30-40 year olds; 91% of medical, 56% of
surgical and 80% of all patients in this age group were HIV-positive.
Seropositive women were younger than seropositive men (median age 29 vs. 35
years, P < 0.0001). Symptoms strongly indicative of HIV were history of shingles,
chronic diarrhoea or fever or cough, history of tuberculosis (TB), weight loss
and persistent itchy rash (adjusted odds ratios [AORs] all > 5). Clinical signs
strongly indicative of HIV were oral hairy leukoplakia, shingles scar, Kaposi's
sarcoma, oral thrush and hair loss (AORs all > 10). Of surgical patients with
'deep infections' (breast abscess, pyomyositis, osteomyelitis, septic arthritis
and multiple abscesses), 52% were HIV-positive (OR compared with other surgical
patients = 2.4). Severe bacterial infections, TB and AIDS caused 68% of deaths.
HIV dominates adult medicine, is a major part of adult surgery, is the main cause
of death in hospital and affects the economically active age group of the
population.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12886812 [PubMed - indexed for MEDLINE]
197: Chemosphere. 2003 Sep;52(10):1727-41.
The contribution of particles washed from rooftops to contaminant loading to
urban streams.
Van Metre PC, Mahler BJ.
US Geological Survey, Research and Investigations, 8027 Exchange Dr., Austin, TX
78754-3898, USA. pcvanmet@usgs.gov
Rooftops are both a source of and a pathway for contaminated runoff in urban
environments. To investigate the importance of particle-associated contamination
in rooftop runoff, particles washed from asphalt shingle and galvanized metal
roofs at sites 12 and 102 m from a major expressway were analyzed for major and
trace elements and PAHs. Concentrations and yields from rooftops were compared
among locations and roofing material types and to loads monitored during runoff
events in the receiving urban stream to evaluate rooftop sources and their
potential contribution to stream loading. Concentrations of zinc, lead, pyrene,
and chrysene on a mass per mass basis in a majority of rooftop samples exceeded
established sediment quality guidelines for probable toxicity of bed sediments to
benthic biota. Fallout near the expressway was greater than farther away, as
indicated by larger yields of all contaminants investigated, although some
concentrations were lower. Metal roofing was a source of cadmium and zinc and
asphalt shingles a source of lead. The contribution of rooftop washoff to
watershed loading was estimated to range from 6 percent for chromium and arsenic
to 55 percent for zinc. Estimated contributions from roofing material to total
watershed load were greatest for zinc and lead, contributing about 20 and 18
percent, respectively. The contribution from atmospheric deposition of particles
onto rooftops to total watershed loads in stormwater was estimated to be greatest
for mercury, contributing about 46 percent.
Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 12871740 [PubMed - indexed for MEDLINE]
198: 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.
Publication Types:
Review
PMID: 12852705 [PubMed - indexed for MEDLINE]
199: Postgrad Med. 2003 Jun;113(6):87-8.
Patient notes: shingles.
[No authors listed]
Publication Types:
Patient Education Handout
PMID: 12838806 [PubMed - indexed for MEDLINE]
200: Ultrastruct Pathol. 2003 May-Jun;27(3):133-40.
Bioterrorism and electron microscopic differentiation of poxviruses from
herpesviruses: dos and don'ts.
Miller SE.
Duke University Medical Center, Durham, North Carolina 27710, USA.
sara.miller@duke.edu
With increased threat of terrorism, much attention is being directed toward
readiness for biodefense. Smallpox virus, a deadly and much feared organism, is
among possible bioterrorism agents. Herpesviruses, such as the one that causes
chickenpox and shingles, produce skin lesions that may resemble those seen early
in smallpox infection. Electron microscopy (EM) is a rapid and reliable method
for differentiating poxviruses from herpesviruses. However, before becoming
involved in the monitoring of potential smallpox cases, a laboratory must
consider several issues, including expertise in virus identification, capacity
for handling biohazards, and health and immune status of laboratory staff.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12775503 [PubMed - indexed for MEDLINE]
201: 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]
202: Nurs Times. 2003 Mar 18-24;99(11):28.
What you need to know about... herpes zoster (shingles).
[No authors listed]
PMID: 12683041 [PubMed - indexed for MEDLINE]
203: Int J Dermatol. 2003 Mar;42(3):193-6.
A seroepidemiologic survey of the prevalence of varicella-zoster virus in the
pediatric population in two university hospitals in Brazil.
Semenovitch I, Lupi O.
Department of Internal Medicine (Dermatology), Antonio Pedro University Hospital,
Fluminense Federal University, Rio de Janeiro, Brazil.
BACKGROUND: Varicella-zoster virus (VZV) is an alpha-herpesvirus causing
varicella (chickenpox) and herpes zoster (shingles). Varicella results from
primary VZV infection, and is a common childhood illness associated with fever
and a generalized, pruritic, vesicular eruption. Herpes zoster is caused by VZV
reactivation later in life (most cases after the fifth decade), and is
characterized by a localized, painful, and vesicular eruption involving one or
adjacent dermatomes. The incidence of herpes zoster increases with age and
immunosuppression. OBJECTIVE: To estimate the seroprevalence of VZV in the
Brazilian pediatric population by evaluating the prevalence of specific
antibodies to VZV in children from two university hospitals in the state of Rio
de Janeiro. METHODS: A population composed of 160 children derived from two
university hospitals in the state of Rio de Janeiro was included in the study.
All patients completed a questionnaire regarding their socio-epidemiologic
characteristics, and a complete physical examination was performed. All blood
samples were screened using a commercial enzyme-linked fluorescent assay (ELFA)
kit, specific for the detection of immunoglobulin G (IgG) antibodies to VZV.
RESULTS: The seroprevalence of VZV was 58.1% in the overall population, with a
statistically significant correlation between seroprevalence and increasing age
(P < 0.0001). A previous history of measles infection (P < 0.04), previous
history of varicella infection (P < 0.0001), and the presence of skin lesions (P
< 0.05) were significantly associated with seropositivity to VZV. CONCLUSIONS:
Further studies should be performed in order to evaluate the endemicity of VZV
infections and to establish criteria for the use of the specific vaccine in
Brazil.
PMID: 12653913 [PubMed - indexed for MEDLINE]
204: J Clin Virol. 2003 Apr;26(3):277-89; discussion 291-3.
Comment in:
J Clin Virol. 2003 Aug;27(3):308-9.
Herpes zoster guideline of the German Dermatology Society (DDG).
Gross G, Schöfer H, Wassilew S, Friese K, Timm A, Guthoff R, Pau HW, Malin JP,
Wutzler P, Doerr HW.
Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Rostock,
Augustenstr. 80-84, D-18055, Rostock, Germany. gerd.gross@med.uni-rostock.de
Varicella zoster virus (VZV) causes varicella (chickenpox), remains dormant in
dorsal root and cranial nerve ganglia and can be reactivated as a consequence of
declining VZV-specific cellular immunity leading to herpes zoster (shingles).
Patients older than 50 years of age affected by herpes zoster may suffer a
significant decrease of quality of life. These patients and immunocompromised
individuals are at increased risks for severe complications, involving the eye,
the peripheral and the central nervous system (prolonged pain, postherpetic
neuralgia). Such complications occur with and without cutaneous symptoms. The
German Dermatology Society (DDG) has released guidelines in order to guarantee
updated management to anyone affected by herpes zoster. Diagnosis is primarily
clinical. The gold standard of laboratory diagnosis comprises PCR and direct
identification of VZV in cell cultures. Detection of IgM- and IgA-anti VZV
antibodies may be helpful in immunocompromised patients. Therapy has become very
effective in the last years. Systemic antiviral therapy is able to shorten the
healing process of acute herpes zoster, to prevent or to alleviate pain and other
acute and chronic complications, particularly, when given within 48 h to a
maximum of 72 h after onset of the rash. Systemic antiviral therapy is urgently
indicated in patients beyond the age of 50 years and in patients at any age with
herpes zoster in the head and neck area, especially in patients with zoster
ophthalmicus. Further urgent indications are severe herpes zoster on the trunk
and on the extremities, herpes zoster in immunosuppressed patients and in
patients with severe atopic dermatitis and severe ekzema. Only relative
indications for antiviral therapy exist in patients younger than 50 years with
zoster on the trunk and on the extremities. In Germany acyclovir, valacyclovir,
famciclovir and brivudin are approved for the systemic antiviral treatment of
herpes zoster. These compounds are all well tolerated by the patients and do not
differ with regard to efficacy and safety. Brivudin has a markedly higher
anti-VZV potency than oral acyclovir, valacyclovir and famciclovir and thus
offers a simpler dosing regimen. It must be given only once daily during 7 days
in comparison to three and five times dosing per day of valacyclovir, famciclovir
and acyclovir, respectively. Brivudin is an antiviral agent with no nephrotoxic
properties, which is an advantage when compared to acyclovir. The most important
aim of therapy of herpes zoster is to achieve painlessness. Appropriately dosed
analgesics in combination with a neuroactive agent (i.e. amitriptylin) are very
helpful when given together with antiviral therapy. The additive therapy with
corticosteroids may shorten the degree and duration of acute zoster pain, but has
no essential effect on the development of postherpetic neuralgia, which is a very
difficult condition to treat. Thus early presentation to a pain therapist is
recommended in specific cases.
Publication Types:
Guideline
Practice Guideline
PMID: 12637076 [PubMed - indexed for MEDLINE]
205: J Med Virol. 2003;70 Suppl 1:S82-9.
Varicella-zoster virus isolates, but not the vaccine strain OKA, induce
sensitivity to alpha-1 and beta-1 adrenergic stimulation of sensory neurones in
culture.
Schmidt M, Kress M, Heinemann S, Fickenscher H.
Abteilung Virologie, Hygiene-Institut, Ruprecht-Karls-Universität Heidelberg, Im
Neuenheimer Feld 324, D-69120 Heidelberg, Germany.
The reactivation of varicella-zoster virus (VZV) from its persistent state in
sensory neurones causes shingles and induces severe, long-lasting pain and
hyperalgesia that often lead to postherpetic neuralgia. To investigate the
VZV-induced neuropathic changes, we established conditions for the active
infection of sensory neurones from rat dorsal root ganglia in vitro. After 2 days
of culture, up to 50% of the cells expressed viral antigens of the
immediate-early and late replication phase. The intracellular calcium ion
concentration was monitored in individual cells by microfluorimetry. Whereas the
calcium response to capsaicin was preserved, the VZV-infected neurones gained an
unusual sensitivity to noradrenaline stimulation in contrast to non-infected
cells. The adrenergic agonists phenylephrine and isoproterenol had a similar
efficacy demonstrating that both alpha(1)- and beta(1)-adrenoreceptors were
involved. The sensitivity to adrenergic stimulation was observed after infection
with different wildtype isolates, but not with the attenuated vaccine strain OKA.
The lack of noradrenaline sensitivity of vaccine-infected neurones demands a
structural comparison of wildtype and vaccine viruses with and without phenotype.
A partial sequence evaluation (26 kb) of the European OKA vaccine strain
surprisingly revealed a series of nucleotide exchanges in comparison to
presumably identical OKA strains from other sources, although VZV is generally
considered genetically stable. In summary, we report that the infection with
wildtype VZV isolates, but not with the vaccine strain, induces noradrenaline
sensitivity in sensory neurones, which correlates with clinical and experimental
observations of adrenergic effects involved in VZV-induced neuralgia. Copyright
2003 Wiley-Liss, Inc.
Publication Types:
In Vitro
Research Support, Non-U.S. Gov't
PMID: 12627494 [PubMed - indexed for MEDLINE]
206: J Med Virol. 2003;70 Suppl 1:S24-30.
A study of shingles and the development of postherpetic neuralgia in East London.
Scott FT, Leedham-Green ME, Barrett-Muir WY, Hawrami K, Gallagher WJ, Johnson R,
Breuer J.
Department of Medical Microbiology, Medical and Dental School, Queen Mary
College, 25-29 Ashfield Street, London E1 1BB, England, UK.
The incidence of post-herpetic neuralgia following shingles and the factors that
are known to predict it were examined in a prospective observational community
study of patients with acute shingles presenting to their family doctors. The
detection of viral DNA in the blood at presentation as a prognostic indicator for
pain was also evaluated. Patients were followed for one year and the persistence
of pain following rash assessed. Among 165 patients who had completed 6 months,
and 139 one-year follow-up, the prevalence of post herpetic neuralgia was 30% at
6 weeks 27% at 12 weeks, 15.9% at 6 months, and 9% at one year. Age and severity
of pain were significantly associated with the persistence of pain beyond 3
months. Viremia at presentation was detected in 66% of patients and was
significantly associated with the presence of pain at six months or beyond.
Antiviral agents were administered to only 50% of those at highest risk of
post-herpetic neuralgia (PHN) mainly because of presentation longer than 72 hours
after the onset of rash. Few patients were prescribed the more potent prodrugs,
Valaciclovir and Famciclovir. In conclusion, treatment of acute shingles in this
observational community-based study was suboptimal in 50% of cases. More accurate
prediction of which subset of elderly patients are most at risk of PHN may enable
targeted prescribing of the most potent drugs to those most likely to benefit.
Copyright 2003 Wiley-Liss, Inc.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12627483 [PubMed - indexed for MEDLINE]
207: Arch Dermatol Res. 2003 Mar;294(12):529-35. Epub 2002 Dec 13.
Number of Langerhans immune cells in painful and non-painful human skin after
shingles.
Oaklander AL, Stocks EA, Mouton PR.
Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD,
USA.
During injury or inflammation, paracrine sensitization of peripheral sensory
neurons by immune cells contributes to the sensation of pain. It is less clear
whether this neural sensitization contributes to neuropathic pain after neural
injury as well. Shingles (herpes zoster) is a common disease that leaves some
patients with prolonged neuropathic pain known as postherpetic neuralgia (PHN).
Sensitization of cutaneous neurons has been hypothesized to contribute to PHN.
Langerhans cells (LC), the Ia(+) macrophages of the skin, contact epidermal
neurites and, when activated, synthesize molecules with the ability to sensitize
axons. For these reasons, we examined morphological evidence for activation of LC
in subjects with established PHN. We also evaluated the relationship between
numbers of LC and nociceptive epidermal nerve endings; these are markedly reduced
in PHN. We used design-based stereology to estimate the number of CD1a(+) LC in
biopsies of painful and non-painful skin from ten adults with or without PHN
after shingles on the torso. There were no differences in the number of LC in
previously shingles-affected and normal-control skin biopsies. The number of LC
also remained at normal levels in biopsies with near-loss of innervation from
shingles. LC numbers were unrelated to the presence or severity of pain. These
data suggest that neuropathic pain in established PHN is not associated with
increased numbers of cutaneous macrophages, and that the number of cutaneous
macrophages in skin from the human torso is independent of the number of
epidermal nerve endings.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 12624778 [PubMed - indexed for MEDLINE]
208: Math Biosci. 2003 Apr;182(2):113-26.
A qualitative analysis of a model for the transmission of varicella-zoster virus.
Schuette MC.
Department of Mathematics and Computer Science, Georgia Southern University,
Statesboro, GA 30460-8093, USA. schuette@gasou.edu
Varicella-zoster virus (VZV) is a herpesvirus which is the known agent for
causing varicella (chickenpox) in its initial manifestation and zoster (shingles)
in a reactivated state. The standard SEIR compartmental model is modified to
include the cycle of shingles acquisition, recovery, and possible reacquisition.
The basic reproduction number R(0) shows the influence of the zoster cycle and
how shingles can be important in maintaining VZV in populations. The model has
the typical threshold behavior in the sense that when R(0)</=1, the VZV
disappears from the population, and when R(0)>1, the virus persists over time and
so chickenpox and shingles remain endemic.
PMID: 12591619 [PubMed - indexed for MEDLINE]
209: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12562395 [PubMed - indexed for MEDLINE]
210: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12558343 [PubMed - indexed for MEDLINE]
211: Pediatr Infect Dis J. 2003 Jan;22(1):96-7.
Comment in:
Pediatr Infect Dis J. 2004 Feb;23(2):185-6; author reply 186.
Varicella-zoster virus: an overlooked cause of aseptic meningitis.
Jhaveri R, Sankar R, Yazdani S, Cherry JD.
Division of Infectious Diseases, Mattel Children's Hospital at UCLA, Los Angeles,
CA 90095-1752, USA. rjhaveri@ucla.edu
Varicella-zoster virus causes varicella (chickenpox) and zoster (shingles).
Neurologic manifestations occur in both illnesses. We describe a previously
healthy child who had aseptic meningitis without exanthem caused by reactivation
of varicella-zoster virus. This has not been previously reported in the pediatric
literature.
PMID: 12553305 [PubMed - indexed for MEDLINE]
212: Eur J Pain. 2003;7(1):1-7.
Erratum in:
Eur J Pain. 2003;7(2):201.
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
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).
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12527312 [PubMed - indexed for MEDLINE]
213: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 12491156 [PubMed - indexed for MEDLINE]
214: J Clin Epidemiol. 2002 Oct;55(10):982-9.
Risk factors for development of systemic lupus erythematosus: allergies,
infections, and family history.
Cooper GS, Dooley MA, Treadwell EL, St Clair EW, Gilkeson GS.
Epidemiology Branch A3-05, National Institute of Environmental Health Sciences,
PO Box 12233, Durham, NC 27709, USA. cooper1@niehs.nih.gov
We examined risk factors for systemic lupus erythematosus (SLE) in 265 recently
diagnosed patients in North Carolina and South Carolina and 355 control subjects
identified through driver's license records and frequency matched to patients by
age, sex, and state. Analyses were limited to exposures before diagnosis (cases)
or reference year (control subjects). SLE patients were more likely than control
subjects to report a history of allergy to medications (odds ratio [OR] 3.1, 95%
confidence interval [CI], 2.1-4.5), particularly to antibiotics. SLE risk
increased with history of shingles (OR 2.5, 95% CI 1.1-5.9) and with frequent
(more than once per year) cold sores in the 3 years before diagnosis (OR 2.8, 95%
CI 1.4-5.4). There was little association with history of mononucleosis, a marker
of late infection with Epstein-Barr virus, implanted medical devices, or
hepatitis B vaccination. History of lupus in parents or siblings was associated
with an increased risk (OR 3.3, 95% CI 1.2-8.6). Further research is needed to
clarify whether medication allergies and specific infectious agents are involved
in the etiology of SLE. Published by Elsevier Science Inc.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 12464374 [PubMed - indexed for MEDLINE]
215: 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]
216: Am J Med. 2002 Oct 15;113(6):462-7.
Novel risk factors for peripheral arterial disease in young women.
Bloemenkamp DG, van den Bosch MA, Mali WP, Tanis BC, Rosendaal FR, Kemmeren JM,
Algra A, Visseren FL, van der Graaf Y.
Julius Center for General Practice and Patient Oriented Research, Department of
Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
PURPOSE: To investigate traditional and novel risk factors (homocysteine and
C-reactive protein levels, and exposure to infections) for peripheral arterial
disease in young women. SUBJECTS AND METHODS: In a multicenter, population-based,
case-control study, 212 young women (mean [+/- SD] age, 48.2 +/- 7.0 years) with
peripheral arterial disease and 475 healthy control women (mean age, 45.5 +/- 8.1
years) completed a standardized questionnaire and provided blood samples.
Peripheral arterial disease was angiographically confirmed if a stenotic lesion
(more than 50% reduction of the lumen) was present in at least one major
peripheral artery. Hyperhomocysteinemia was defined as a nonfasting plasma
homocysteine level exceeding the 90th percentile of the control group. History of
infectious diseases was determined by questionnaire. RESULTS: Elevated C-reactive
protein levels were associated with an increased likelihood of peripheral
arterial disease (odds ratio [OR] = 3.9; 95% confidence interval [CI]: 1.8 to 8.5
for women in the third quartile; OR = 3.1; 95% CI: 1.4 to 6.8 for women in the
fourth quartile; both comparisons with women in the first quartile).
Hyperhomocysteinemia was not associated with a significantly increased risk of
peripheral arterial disease (OR = 1.6; 95% CI: 0.9 to 3.0). A history of
chickenpox, shingles, mumps, pneumonia, chronic bronchitis, peptic ulcer, or
periodontitis was independently related to peripheral arterial disease, with
adjusted odds ratios varying from 1.7 (95% CI: 1.0 to 3.1) for mumps to 3.4 (95%
CI: 1.5 to 7.7) for peptic ulcer. The risk of peripheral arterial disease
increased with the number of these infections; exposure to five or more
infections increased the odds 3.7-fold (95% CI: 1.7 to 8.2). This association was
not affected by the level of C-reactive protein. CONCLUSION: Our results do not
support a strong relation between homocysteine and peripheral arterial disease in
young women. However, an elevated C-reactive protein level and several types of
symptomatic infection were associated with peripheral arterial disease.
Publication Types:
Multicenter Study
Research Support, Non-U.S. Gov't
PMID: 12427494 [PubMed - indexed for MEDLINE]
217: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12423693 [PubMed - indexed for MEDLINE]
218: Proc Natl Acad Sci U S A. 2002 Nov 12;99(23):15234-7. Epub 2002 Oct 30.
Herpes viruses hedge their bets.
Stumpf MP, Laidlaw Z, Jansen VA.
Department of Biology, University College London, United Kingdom.
m.stumpf@ucl.ac.uk
Static latency is the hallmark of all herpes viruses. The varicella zoster virus,
for instance, causes varicella (chickenpox), and after a latent phase of between
5 and 40 years, it can give rise to herpes zoster (shingles). This latency and
the subsequent reactivation has intrigued and puzzled virologists. Although
several factors have been suggested, it is unknown what triggers reactivation.
However, latency can be explained with a simple evolutionary model. Here, we
demonstrate that a simple, yet efficient, bet-hedging strategy might have evolved
in a number of viruses, especially those belonging to the herpes virus family and
most importantly in varicella zoster virus. We show that the evolution of latency
can be explained by the population dynamics of infectious diseases in fluctuating
host populations.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 12409612 [PubMed - indexed for MEDLINE]
219: Afr Health. 1998 Nov;21(1):5-6.
Herpes zoster: an early manifestation of HIV infection.
Leppard B, Naburi AE.
PIP: Herpes zoster, also known as shingles, is a reactivation of a previous
infection with the herpes varicella-zoster virus. A person's first encounter with
the virus causes chicken pox, usually in children. Once the chicken pox has
healed, the virus remains in the posterior root ganglion of the spinal cord for
the rest of the person's life. If a person's immunity is reduced for any reason,
the virus can be reactivated, travel down one of the sensory nerves to the skin
and cause herpes zoster. Herpes zoster cannot be contracted from someone who has
it, for the infection always comes from one's own spinal cord. However, chicken
pox can be caught from someone with herpes zoster. Before signs of herpes zoster
become apparent on the skin, there is pain along the course of one of the sensory
nerves of the skin. A rash then appears 2-3 days later, beginning with grouped
vesicles either confined to 1 dermatome or spread over 2 adjacent dermatomes. The
vesicles will later crust over before healing in 3-4 weeks. The rash remains
painful until it has healed. Herpes zoster-related problems at the eye, tongue,
chest and abdomen, and bladder and bowel are noted. In Africa, the presentation
of a patient with herpes zoster should always lead the clinician to suspect HIV
infection, for since the beginning of the AIDS pandemic, herpes zoster has often
been the first manifestation of HIV infection. Various treatments with analgesics
and topical and antiretroviral agents are described.
PMID: 12294921 [PubMed - indexed for MEDLINE]
220: 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.
Publication Types:
Comparative Study
PMID: 12224692 [PubMed - indexed for MEDLINE]
221: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 12211045 [PubMed - indexed for MEDLINE]
222: 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
Publication Types:
Case Reports
Review
PMID: 12197826 [PubMed - indexed for MEDLINE]
223: 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.
Publication Types:
Review
PMID: 12118839 [PubMed - indexed for MEDLINE]
224: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 12099726 [PubMed - indexed for MEDLINE]
225: Ann Rheum Dis. 2002 Jul;61(7):661.
Shingles following infliximab infusion.
Baumgart DC, Dignass AU.
Publication Types:
Case Reports
Letter
PMID: 12079920 [PubMed - indexed for MEDLINE]
226: Mayo Clin Health Lett. 2002 Jun;20(6):7.
Shingles. Seek early treatment.
[No authors listed]
Publication Types:
Review
PMID: 12066808 [PubMed - indexed for MEDLINE]
227: 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.
Publication Types:
Review
PMID: 12066061 [PubMed - indexed for MEDLINE]
228: 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.
Publication Types:
Case Reports
PMID: 12039124 [PubMed - indexed for MEDLINE]
229: J Clin Pathol. 2002 May;55(5):399; author reply 399.
Comment on:
J Clin Pathol. 2001 Oct;54(10):743-7.
Vaccination to prevent varicella and shingles.
Katona SJ.
Publication Types:
Comment
Letter
PMID: 11986353 [PubMed - indexed for MEDLINE]
230: JAMA. 2002 May 1;287(17):2211; author reply 2211-2.
Comment on:
JAMA. 2002 Feb 6;287(5):606-11.
Varicella vaccine and shingles.
Brisson M, Edmunds WJ, Gay NJ, Miller E.
Publication Types:
Comment
Letter
PMID: 11980518 [PubMed - indexed for MEDLINE]
231: Ostomy Wound Manage. 2002 Mar;48(3):24-7.
Healing shingles with moist occlusive dressings.
Lee SK.
Publication Types:
Case Reports
PMID: 11968892 [PubMed - indexed for MEDLINE]
232: 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]
233: 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.
Publication Types:
Case Reports
Research Support, Non-U.S. Gov't
PMID: 11932056 [PubMed - indexed for MEDLINE]
234: 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.
Publication Types:
Review
PMID: 11924825 [PubMed - indexed for MEDLINE]
235: 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]
236: 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.
Publication Types:
Case Reports
Review
PMID: 11898565 [PubMed - indexed for MEDLINE]
237: Plant Physiol. 2002 Mar;128(3):1022-30.
Ferrous ion transport across chloroplast inner envelope membranes.
Shingles R, North M, McCarty RE.
Department of Biology, Johns Hopkins University, Baltimore, Maryland 21218-2685,
USA. shingles@jhu.edu
The initial rate of Fe(2+) movement across the inner envelope membrane of pea
(Pisum sativum) chloroplasts was directly measured by stopped-flow
spectrofluorometry using membrane vesicles loaded with the Fe(2+)-sensitive
fluorophore, Phen Green SK. The rate of Fe(2+) transport was rapid, coming to
equilibrium within 3s. The maximal rate and concentration dependence of Fe(2+)
transport in predominantly right-side-out vesicles were nearly equivalent to
those measured in largely inside-out vesicles. Fe(2+) transport was stimulated by
an inwardly directed electrochemical proton gradient across right-side-out
vesicles, an effect that was diminished by the addition of valinomycin in the
presence of K(+). Fe(2+) transport was inhibited by Zn(2+), in a competitive
manner, as well as by Cu(2+) and Mn(2+). These results indicate that
inward-directed Fe(2+) transport across the chloroplast inner envelope occurs by
a potential-stimulated uniport mechanism.
Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 11891257 [PubMed - indexed for MEDLINE]
238: 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.
Publication Types:
Case Reports
PMID: 11830629 [PubMed - indexed for MEDLINE]
239: Bone Marrow Transplant. 2001 Dec;28(12):1105-9.
Immunologic recovery after autologous blood stem cell transplantation in patients
with AL-amyloidosis.
Akpek G, Lenz G, Lee SM, Sanchorawala V, Wright DG, Colarusso T, Waraska K,
Lerner A, Vosburgh E, Skinner M, Comenzo RL.
Section of Hematology and Oncology, Department of Medicine, Boston University
Medical Center, Boston, MA, USA.
We prospectively studied absolute lymphocyte (ALC) and monocyte counts (AMC),
lymphocyte subsets and proliferative in vitro responses to mitogen and antigen in
12 patients with AL-amyloidosis (AL) undergoing autologous blood stem cell
transplantation (SCT) with high-dose i.v. melphalan. Myeloid and lymphoid
recovery (>500 per microl) occurred in a median of 10 days post SCT. While there
was a continuous decline in the number of CD4+ T cells at 3 months, ALC, AMC, B
cells (CD19+), CD8+ T cells, and NK cells (CD16+/56+) returned to baseline. While
T cell proliferative responses to phytohemagglutinin (PHA) remained depressed, B
cell function measured by the proliferative response to staphylococcal antigen
returned to baseline by 3 months. To supplement our findings, we retrospectively
evaluated ALC, AMC and serum immunoglobulin levels in a separate group of
patients treated with the same protocol at our institution. ALC and AMC recovery
was similar to the pattern observed in the initial study group. Immunoglobulin
levels remained within normal ranges at 3 and 12 months after SCT. Of 50 patients
who were followed for a minimum of 1 year following SCT, seven (14%) developed
shingles and one (2%) had PCP pneumonia. In conclusion, cellular immune function,
reflected by absolute numbers of CD4+ T cells and PHA responsive T cell
proliferation, is significantly suppressed at 3 months after SCT in patients with
AL, and this post-transplant immunosuppression is associated with a low but
clinically meaningful occurrence of opportunistic infections typical of T cell
immunosuppression.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 11803350 [PubMed - indexed for MEDLINE]
240: Rev Med Virol. 2002 Jan-Feb;12(1):5-11.
Studies on shingles, is the virus ordinary chickenpox virus?
Breuer J.
Publication Types:
Biography
Classical Article
Historical Article
Personal Name as Subject:
Simpson RE
PMID: 11787080 [PubMed - indexed for MEDLINE]
241: J Foot Ankle Surg. 2001 Nov-Dec;40(6):411-3.
Toxic shock syndrome originating from the foot.
Arnold J, Lucarelli M, Cutrona AF, DiDomenico LA, Karlock L.
Forum Health, Department of Podiatric Medicine, Youngstown, OH 44501, USA.
The most familiar etiology of toxic shock syndrome (TSS) is that of menstruation
and tampon use. Nonmenstrual TSS has been described in all types of wounds
including postsurgical, respiratory infection, mucous membrane disruption, burns,
and vesicular lesions caused by varicella and shingles. A case of TSS occurring
in a diabetic male patient with foot blisters is presented. Early recognition by
an infectious disease specialist and appropriate medical management led to
complete recovery. There have been no reported cases of Staphylococcus aureus TSS
originating in the foot to date.
Publication Types:
Case Reports
PMID: 11777238 [PubMed - indexed for MEDLINE]
242: 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.
Publication Types:
Review
PMID: 11772333 [PubMed - indexed for MEDLINE]
243: 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.
Publication Types:
Review
PMID: 11766559 [PubMed - indexed for MEDLINE]
244: J Healthc Inf Manag. 2001 Fall;15(3):223-35.
Next phase of medical management systems: automating administrative transactions
to integrate payors and providers.
Shingles RB, Shaman HJ, Kongstvedt PR, Hohner JH.
Today, medical management is burdened by the cost and hassle of manual
administrative tasks. Manual intensive processing (that is, phone and fax) of
referral requests and institutional authorization transactions results in
significant unnecessary costs for the providers and payors, delays in approval,
and problems with errors. To address these administrative burdens, the next phase
of online (Internet- and wireless-enabled) medical management applications will
focus on the administrative and transaction side, including self-service referral
and authorization processing between the payor and provider. The advent of the
Health Insurance Portability and Accountability Act (HIPAA) greatly improves the
ability to gain widespread adoption of these online applications thanks to
mandated standardization of many routine transactions. This article explores this
next phase of online administrative and transaction medical management
applications from the payors' perspective and explores their connectivity with
providers. Payors are striving to meet several objectives as they implement these
online administrative and transaction medical management systems: reducing the
administrative burden and cost, changing traditional medical policies, increasing
provider adoption of connective technologies, addressing HIPAA compliance, and
achieving higher levels of system integration.
PMID: 11642141 [PubMed - indexed for MEDLINE]
245: 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.
Publication Types:
Review
PMID: 11641861 [PubMed - indexed for MEDLINE]
246: J Clin Pathol. 2001 Oct;54(10):743-7.
Comment in:
J Clin Pathol. 2002 May;55(5):399; author reply 399.
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
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.
PMID: 11577118 [PubMed - indexed for MEDLINE]
247: 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.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 11557467 [PubMed - indexed for MEDLINE]
248: Brain Pathol. 2001 Oct;11(4):440-51.
The expanding spectrum of herpesvirus infections of the nervous system.
Kleinschmidt-DeMasters BK, Gilden DH.
Department of Neurology, The University of Colorado Health Sciences Center,
Denver 80262, USA. BK.DeMasters@UCHSC.edu
Herpesviruses cause various acute, subacute, and chronic disorders of the central
(CNS) and peripheral (PNS) nervous systems in adults and children. Both
immunocompetent and immunocompromised individuals may be affected. Zoster
(shingles), a result of reactivation of varicella zoster virus (VZV), is the most
frequent neurologic complication. Other neurological complications include
encephalitis produced by type I herpes simplex virus (HSV-1), and less frequently
HSV-2, as well as by VZV and cytomegalovirus (CMV). Acute meningitis is seen with
VZV and HSV-2, and benign recurrent meningitis with HSV-2. Combinations of
meningitis/ encephalitis and myelitis/radiculitis are associated with Epstein
Barr Virus (EBV); myelitis with VZV, CMV, EBV, and HSV-2; and
ventriculitis/encephalitis with VZV and CMV. Brainstem encephalitis due to HSV
and VZV, and polymyeloradiculitis due to CMV are well documented. HHV-6 produces
childhood exanthem subitum (roseola) and febrile convulsions. Immunocompetent and
immunocompromised hosts manifest different incidences and patterns of herpesvirus
infections. For example, stroke due to VZV-mediated large vessel disease (herpes
zoster ophthalmicus) occurs predominantly in immunocompetent hosts, while small
vessel disease (leukoencephalitis) and ventriculitis develop almost exclusively
in immunocompromised patients. EBV-associated primary CNS lymphomas also are
restricted to immunosuppressed individuals. Recent large CSF PCR studies have
shown that VZV, EBV, and CMV more frequently produce meningitis, encephalitis, or
encephalopathy in immunocompetent hosts than was formerly realized. We review
herpesvirus infections of the nervous system and illustrate the expanding
spectrum of disease by including examples of a 75-year-old male on steroid
treatment for chronic lung disease with fatal HSV-2 meningitis and an 81-year-old
male with myasthenia gravis, long-term azathioprine use, and an EBV-associated
primary CNS lymphoma.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 11556690 [PubMed - indexed for MEDLINE]
249: J Exp Biol. 2001 Aug;204(Pt 15):2691-8.
Effects of sublethal ammonia exposure on swimming performance in rainbow trout
(Oncorhynchus mykiss).
Shingles A, McKenzie DJ, Taylor EW, Moretti A, Butler PJ, Ceradini S.
School of Biosciences, University of Birmingham, Birmingham, B15 2TT, UK.
Adult trout Oncorhynchus mykiss fitted with a dorsal aortic catheter were exposed
to 288+/-15 micromol l(-1) (mean +/- S.E.M.) total ammonia for 24h in water at a
pH of 8.39+/-0.02, while swimming at a speed equivalent to 0.75 bodylengths s(-1)
(BLs(-1)) in a Brett-type tunnel respirometer. The fish were then exposed to
stepwise increments in swimming speed (0.25 BLs(-1) every 30 min) until
exhaustion. Measurements of oxygen uptake (M(O2)) and plasma total ammonia levels
and pH were made at each speed. Control trout were treated identically but
without exposure to ammonia. Ammonia exposure caused an increase in plasma total
ammonia level to 436+/-34 micromol l(-1), compared to 183+/-30 micromol l(-1)in
control animals (N=6). A significant reduction in total plasma ammonia level was
found in both groups during exercise, despite a large negative concentration
gradient in those exposed to an elevated concentration of ammonia in water, which
may indicate an active excretory process. The overall increase in plasma ammonia
levels in exposed trout was associated with a significant reduction in critical
swimming speed (U(crit)) to 1.61+/-0.17BL s(-1) from 2.23+/-0.15BL s(-1) in
control animals. Ammonia-exposed trout had a significantly higher maintenance
metabolic rate (MMR) than control fish, when estimated as the y-intercept of the
relationship between swimming speed and M(O2). Active metabolic rate (AMR,
maximum M(O2) as measured at U(crit)) was significantly lower in ammonia-exposed
animals, leading to a profound reduction in factorial aerobic scope (AMR/MMR).
Reduced U(crit) was also linked to a reduction in maximum tailbeat frequency.
Calculation of membrane potentials (E(M)) in the white muscle of fish swum to
U(crit) revealed a significant partial depolarisation of white muscle in
ammonia-exposed fish. This may have prevented white muscle recruitment and
contributed to the reduced maximum tailbeat frequency and overall impairment of
swimming performance in the ammonia-exposed fish.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 11533119 [PubMed - indexed for MEDLINE]
250: Anal Biochem. 2001 Sep 1;296(1):106-13.
Direct measurement of ferrous ion transport across membranes using a sensitive
fluorometric assay.
Shingles R, North M, McCarty RE.
Department of Biology, Johns Hopkins University, Baltimore, Maryland 21218-2685,
USA.
The fluorophore, Phen Green SK (PGSK), was assessed for its suitability to be
used in an assay for ferrous ion transport into membrane vesicles. The long
wavelengths of excitation and emission (506 and 520 nm, respectively) enable PGSK
fluorescence to be detected in membranes, such as the chloroplast inner envelope,
that contain high levels of carotenoids which absorb light at lower wavelengths.
At low concentrations of Fe2+, less than 3 microM, the interaction between PGSK
and Fe2+ appears to result in both static and dynamic quenching of the PGSK
fluorescence. The characteristics of this quenching were used to develop a
calibration curve to determine the concentration of free Fe2+ at these low
concentrations. Pronounced quenching of PGSK fluorescence entrapped within
chloroplast inner envelope membrane vesicles was observed when Fe2+ was added.
The extent of quenching of PGSK fluorescence trapped inside asolectin vesicles on
Fe2+ addition was much less. The kinetics of the quenching of PGSK fluorescence
by Fe2+ in vesicles was quite different from that for PGSK and Fe2+ in solution.
Using the calibration curve developed for interaction of PGSK and low Fe2+
concentrations the initial rates of iron transport could be determined for the
chloroplast inner envelope membranes. Copyright 2001 Academic Press.
Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 11520038 [PubMed - indexed for MEDLINE]
251: Med Hypotheses. 2001 Sep;57(3):310-2.
Does supplemental creatine prevent herpes recurrences?
Ness SR, McCarty MF.
Pantox Laboratories, San Diego, California 92109, USA.
While functioning as a general practitioner at the Camp Pendleton Marine Base,
the first author treated numerous patients with recurrent genital herpes.
Beginning in 1998, a number of these patients failed to return for periodic
acyclovir therapy. Inquiries revealed that these patients had all commenced
supplemental creatine after their last outbreak, and had experienced no further
outbreaks. A literature search uncovered a report that cyclocreatine, a synthetic
compound structurally and functionally homologous to creatine, inhibits the
replication of cytomegalovirus, varicella-zoster, and herpes simplex types 1 and
2, in low millimolar concentrations; furthermore, dietary cyclocreatine reduces
morbidity and mortality in mice infected with HSV-2. The fact that both creatine
and cyclocreatine exert neuroprotective and cancer-retardant effects in rodents,
encourages the speculation that creatine shares the anti-viral activity of
cyclocreatine. Pilot studies to assess the impact of creatine loading on
recurrence of oral and genital herpes appear warranted; the impact of creatine on
shingles occurrence in high-risk patients could also be explored. Although
initially conceived as an aid to athletic performance, creatine loading may prove
to have broad preventive and therapeutic applications.
PMID: 11516222 [PubMed - indexed for MEDLINE]
252: Stat Med. 2001 Aug 30;20(16):2429-39.
Comment in:
Stat Med. 2006 Jan 30;25(2):359-60.
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.
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.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 11512133 [PubMed - indexed for MEDLINE]
253: Curr Treat Options Neurol. 2001 Sep;3(5):401-411.
Shingles (Herpes Zoster) and Post-herpetic Neuralgia.
Davis LE, King MK.
Departments of Neurology, Neuroscience, and Microbiology, New Mexico VA Health
Care System, 1501 San Pedro Drive, SE, Albuquerque, NM 87108, USA.
LEDavis@UNM.edu
During childhood chickenpox, varicella-zoster virus becomes latent in neurons of
the dorsal root or trigeminal ganglia. Shingles results years to decades later
from a breakdown of viral latency within a ganglion and subsequent virus spread
to the skin producing a unilateral dermatomal vesicular rash accompanied by
segmental pain. Treatment with famciclovir, valacyclovir, and high dose acyclovir
is beneficial if started within the first 3 days of the rash. All three drugs can
be given orally, are equally effective, shorten the duration of viral shedding
and time to healing of the rash by 1 to 2 days, and lessen the intensity and
duration of the acute neuritic pain. Famciclovir and valacyclovir have more
convenient dosing schedules (three times daily) compared to acyclovir (five times
daily). Mild cases of shingles in younger healthy individuals often do not
require any antiviral treatment. Pain in shingles may have burning, lancinating,
or allodynic qualities, ranges in intensity from mild to unbearable, and lasts 2
to 8 weeks. Pain treatment varies on the type and intensity of pain experienced.
In a few patients, post-herpetic neuralgia develops and the dermatomal pain
persists for months to years. Effective treatment of post-herpetic pain is often
difficult.
PMID: 11487454 [PubMed - as supplied by publisher]
254: FDA Consum. 2001 May-Jun;35(3):21-5.
Shingles.
Zamula E.
PMID: 11458545 [PubMed - indexed for MEDLINE]
255: Am J Epidemiol. 2001 Jul 15;154(2):161-5.
Prevalence of antibodies to four herpesviruses among adults with glioma and
controls.
Wrensch M, Weinberg A, Wiencke J, Miike R, Barger G, Kelsey K.
Department of Epidemiology and Biostatistics, School of Medicine, University of
California, San Francisco, CA 94143-1215, USA. wrensch@itsa.ucsf.edu
The authors previously reported statistically significant inverse associations
between adult onset glioma and histories of chickenpox and shingles among 462
cases and 443 controls in the San Francisco Bay Area Adult Glioma Study
(1991--1995) and a suggestive but nonsignificant inverse association with
immunoglobulin G antibodies to varicella-zoster virus in a small subset of these
cases. This report considers antibodies to four common herpesviruses (varicella
zoster, herpes simplex, cytomegalovirus, and Epstein Barr) among 134 cases and
165 controls that represent all subjects for whom usable blood specimens were
available. The prevalences of immunoglobulin G antibodies to varicella-zoster
virus, herpes simplex virus, cytomegalovirus, and Epstein-Barr virus were 90%,
71%, 57%, and 90%, respectively. After adjustment for age, White versus non-White
ethnicity, and gender, glioblastoma cases were less likely than controls to have
immunoglobulin G antibodies to varicella-zoster virus (odds ratio = 0.4; 95%
confidence interval: 0.1, 0.9). They were also somewhat less likely to have
antibodies to Epstein-Barr virus but somewhat more likely to have antibodies to
herpes simplex virus and cytomegalovirus. Antibody prevalences to all four
herpesviruses were similar between cases with other glioma histologies and
controls. These results corroborate our previously suggestive findings of an
inverse association of varicella-zoster virus antibodies with adult onset glioma.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 11447050 [PubMed - indexed for MEDLINE]
256: Ann Rheum Dis. 2001 Jul;60(7):719.
A case of shingles mimicking carpal tunnel syndrome.
Wilson H, Hamilton J, Madhok R.
Publication Types:
Case Reports
Letter
PMID: 11436859 [PubMed - indexed for MEDLINE]
257: Hautarzt. 2001 Jun;52(6):492-8.
[Development of the German Scale for Assessing Quality of Life in Skin Diseases]
[Article in German]
Schäfer T, Staudt A, Ring J.
MPH, Klinik und Poliklinik fГјr Dermatologie und Allergologie der Technischen
Universität München, Biedersteiner Strasse 29. tschafer@lrz.tum.de
BACKGROUND AND OBJECTIVE: A German dermatological quality-of-life (QoL)
instrument was developed on the basis of a representative and standardised
patient population. PATIENTS/METHODS: Qualitative interviews were performed in
633 patients. Based on the answers of 20 patients from each of the 10 most
frequent diagnostic groups, items were identified and a questionnaire developed.
This was used in 704 patients and eventually the number of items was reduced.
RESULTS: The long version of the instrument has 72 items. The median of the total
score of the questionnaire was 75 and significantly different between diagnostic
groups (herpes/shingles 110, verruca 26; p < 0.001). Significant differences
occurred also between questionnaire domains with categories "psychological,
physical, and treatment" showing the highest results. In contrast to the total
group, patients with urticaria scored highest in dimensions "social, leisure, and
work" (p < 0.001). By factor analysis the number of items was reduced to 36.
CONCLUSIONS: The DIELH was developed on the basis of a standardised and
representative patient population. The long version proved to have a good
discriminant validity with respect to diagnostic groups and dimensions.
Publication Types:
English Abstract
Research Support, Non-U.S. Gov't
PMID: 11428077 [PubMed - indexed for MEDLINE]
258: 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.
Publication Types:
Review
PMID: 11417752 [PubMed - indexed for MEDLINE]
259: 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.
Publication Types:
Comparative Study
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 11371229 [PubMed - indexed for MEDLINE]
260: BETA. 1999;12(4):67-70.
HIV skin complications in the age of HAART: an interview with Toby Maurer.
Maurer T.
University of California at San Francisco.
AIDS: Kaposi's sarcoma is one of the symbols of AIDS, but other skin
complications are common in HIV-infected persons: herpes zoster (shingles),
herpes simplex, and molliscum contagiosum. Skin complications are painful and
disfiguring, and can significantly reduce a patient's quality of life. Dr. Toby
Maurer of the University of California at San Franscisco updates readers on
dermatological issues, including skin complications related to the use of
anti-HIV drugs.
Publication Types:
Interview
Newspaper Article
PMID: 11367263 [PubMed - indexed for MEDLINE]
261: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 11359293 [PubMed - indexed for MEDLINE]
262: Mayo Clin Health Lett. 2001 May;19(5):4.
Steroid shots may help pain after shingles.
[No authors listed]
Publication Types:
News
PMID: 11349633 [PubMed - indexed for MEDLINE]
263: Arch Virol Suppl. 2001;(17):81-9.
The role of varicella zoster virus immediate-early proteins in latency and their
potential use as components of vaccines.
Sadzot-Delvaux C, Rentier B.
Department of Microbiology, Fundamental Virology, LiГЁge University, Sart
Tilman-LiГЁge, Belgium.
Varicella zoster virus immediate-early (IE) proteins are intracellular regulators
of viral gene expression. Some of them (IE62 and IE63) are found in large amounts
in infected cells but are also components of the virion tegument. Several IE and
early genes are transcribed during latency, while late genes are not. Recently,
we demonstrated the presence of protein IE 63 in dorsal root ganglia of
persistently infected rats as well as in normal human ganglia; other IE proteins
have been found since in human ganglia. Cell-mediated immunity (CMI) to IE 62 has
been evidenced. We found both humoral immunity and CMI to IE 63 in immune adults.
In elderly zoster-free individuals, CMI to IE 63 remained high. The differences
in the CMI to IE 63 among young adults, elderly people and immunocompromized
patients have to be analyzed according to their status relative to zoster, to
determine whether the decrease in CMI, particularly to IE proteins, could be
responsible for viral reactivation and for the onset of shingles. Hopefully, the
waning of the CMI to VZV IE 63 and perhaps to other IE proteins could become a
predictive marker for herpes zoster and reimmunization, not only with the vaccine
strain, but also with purified IE proteins could help prevent zoster at old age.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 11339554 [PubMed - indexed for MEDLINE]
264: 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.
Publication Types:
Review
PMID: 11323945 [PubMed - indexed for MEDLINE]
265: Pain. 2001 May;92(1-2):139-45.
Erratum in:
Pain 2001 Dec;94(3):325.
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
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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 11323135 [PubMed - indexed for MEDLINE]
266: 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]
267: 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 fГјr 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 11292665 [PubMed - indexed for MEDLINE]
268: 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.
Publication Types:
Review
PMID: 11062626 [PubMed - indexed for MEDLINE]
269: Expert Opin Investig Drugs. 2000 Aug;9(8):1743-51.
Novel agents for the therapy of varicella-zoster virus infections.
Snoeck R, Andrei G, De Clercq E.
Rega Institute for Medical Research, K.U.Leuven, Minderbroedersstraat 10, B-3000
Leuven, Belgium. robert.snoeck@rega.kuleuven.ac.be
Varicella-zoster virus (VZV), a member of the herpesvirus family, is responsible
for both primary (varicella or chickenpox) as well as recurrent (zoster or
shingles) infections. Acyclovir has been the mainstay for treating VZV infections
in both immunocompetent and immunocompromised patients. Recently, newer anti-VZV
drugs, i.e., valaciclovir (the oral prodrug form of acyclovir) and famciclovir
(the oral prodrug form of penciclovir) have been developed and have enlarged the
therapeutic options to treat VZV infections. Both acyclovir and penciclovir are
dependent on the virus-encoded thymidine kinase (TK) for their intracellular
activation. Although emergence of drug-resistant strains does not occur in
immunocompetent patients, several reports have documented the isolation of
drug-resistant VZV strains following long-term acyclovir therapy in
immunocompromised patients. Mutations at the level of the TK are responsible for
development of resistance to drugs that depend on the viral TK for their
phosphorylation (i.e., acyclovir and penciclovir). Foscarnet, a direct inhibitor
of the viral DNA polymerase, which does not require activation by the viral TK,
is the drug of choice for the treatment of TK-deficient VZV mutants emerging
under acyclovir therapy. Recently, emergence of foscarnet-resistant strains has
also been reported. Both TK-deficient strains and foscarnet-resistant mutants are
sensitive to the acyclic nucleoside phosphonate cidofovir, CDV, HPMPC,
(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine. This agent does not depend
on the virus-encoded TK, but on cellular enzymes for its conversion to the
diphosphoryl derivative, which then inhibits the viral DNA polymerase.
Publication Types:
Review
PMID: 11060773 [PubMed - indexed for MEDLINE]
270: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 11060588 [PubMed - indexed for MEDLINE]
271: Health News. 2000 Jan;6(1):6.
Blocking shingles pain.
[No authors listed]
Publication Types:
News
PMID: 11019661 [PubMed - indexed for MEDLINE]
272: 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.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.
PMID: 11014390 [PubMed - indexed for MEDLINE]
273: Harv Womens Health Watch. 2000 Sep;8(1):5.
Shingles vaccine trial underway.
[No authors listed]
PMID: 10966601 [PubMed - indexed for MEDLINE]
274: Virology. 2000 Sep 1;274(2):420-8.
Sequence analysis of the leftward end of simian varicella virus (EcoRI-I
fragment) reveals the presence of an 8-bp repeat flanking the unique long segment
and an 881-bp open-reading frame that is absent in the varicella zoster virus
genome.
Mahalingam R, White T, Wellish M, Gilden DH, Soike K, Gray WL.
Department of Neurology, University of Colorado Health Sciences Center, Denver,
Colorado 80262, USA. ravi.mahalingam@UCHSC.edu
Simian varicella virus (SVV) causes varicella (chickenpox) in nonhuman primates,
becomes latent in cranial and dorsal root ganglia, and reactivates to produce
zoster (shingles). Because the clinical and molecular features of SVV closely
resemble those of varicella zoster virus (VZV) infection of humans, SVV infection
of primates has served as an experimental model of VZV pathogenesis and latency.
The SVV genome has been completely mapped, but attempts to clone the 3600-bp
EcoRI fragment located at the leftward end of the virus genome have hitherto been
unsuccessful. Herein, we report the cloning and the complete nucleotide sequence
of this region. Comparison of the SVV and VZV sequences in this region revealed
an 8-bp inverted repeat sequence flanking the unique long segment of the SVV
genome; an 879-bp open-reading frame (ORF) A in SVV that is absent in VZV but has
42% amino acid identity to SVV ORF 4 and 49% to VZV ORF 4; a 342-bp ORF B in SVV
with 35% amino acid identity to a 387-bp ORF located to the left of ORF 1 on the
VZV genome; and a 303-bp ORF in SVV with 27% amino acid identity to VZV ORF 1. No
homologue of VZV ORF 2 was detected. Transcripts specific for ORFs A and B were
present in SVV-infected cells in culture and in acutely infected monkey ganglia.
Overall, there are more than 2000 bp of DNA in the SVV genome that are absent in
the VZV genome. Copyright 2000 Academic Press.
Publication Types:
Comparative Study
Research Support, U.S. Gov't, P.H.S.
PMID: 10964784 [PubMed - indexed for MEDLINE]
275: 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.
Publication Types:
Case Reports
Review
PMID: 10943192 [PubMed - indexed for MEDLINE]
276: 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.
Publication Types:
Case Reports
PMID: 10861772 [PubMed - indexed for MEDLINE]
277: J Ethnopharmacol. 2000 Jun;70(3):235-73.
Medicinal plants and food medicines in the folk traditions of the upper Lucca
Province, Italy.
Pieroni A.
Dipartimento di Scienza del Suolo e Nutrizione della Pianta, UniversitГ degli
Studi di Firenze, Piazzale delle Cascine, 28, I-50144, Florence, Italy.
uzs51a@uni-bonn.de
An ethnopharmacobotanical survey of the medicinal plants and food medicines of
the northern part of Lucca Province, north-west Tuscany, central Italy, was
carried out. The geographical isolation of this area has permitted the survival
of a rich folk phytotherapy involving medicinal herbs and also vegetable
resources used by locals as food medicine. Among these are the uncommon use of
Ballota nigra leaves as a trophic protective; the use of Lilium candidum bulbs as
an antiviral to treat shingles (Herpes zoster); Parmelia sp. as a cholagogue;
Crocus napolitanus flowers as antiseptic; Prunus laurocerasus drupes as a
hypotensive; and the consumption of chestnut flour polenta cooked with new wine
as bechic. Many wild gathered greens are eaten raw in salads, or in boiled
mixtures, as 'blood cleansing' and 'intestine cleansing' agents. Of particular
interest is the persistence of the archaic use of Bryonia dioica root against
sciatica, and the use of ritual plant therapeuticals as good omens, or against
the 'evil eye.' Over 120 species represent the heritage of the local folk
pharmacopoeia in upper Garfagnana. Anthropological and ethnopharmacological
considerations of the collected data are also discussed.
PMID: 10837988 [PubMed - indexed for MEDLINE]
278: 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.
Publication Types:
Review
PMID: 10794584 [PubMed - indexed for MEDLINE]
279: J Neurol. 2000 Mar;247(3):218-9.
Bickerstaff's brainstem encephalitis associated with shingles.
Tagawa Y, Yuki N.
Publication Types:
Case Reports
Letter
Research Support, Non-U.S. Gov't
PMID: 10787119 [PubMed - indexed for MEDLINE]
280: Brain. 2000 Apr;123 ( Pt 4):665-76.
Comment in:
Brain. 2000 Apr;123 ( Pt 4):663-4.
The incidence and lifetime prevalence of neurological disorders in a prospective
community-based study in the UK.
MacDonald BK, Cockerell OC, Sander JW, Shorvon SD.
Institute of Neurology and National Hospital for Neurology and Neurosurgery,
Queen Square, London WC1N 5BG, UK.
Over an 18-month period, all incident cases of neurological disorders were
ascertained prospectively in an unselected urban population based in 13 general
practices in the London area by a General Practice Linkage Scheme with the
National Hospital for Neurology and Neurosurgery. In three of these practices,
the lifetime prevalence of neurological disorders was also assessed. A population
of 100 230 patients registered with participating general practices was followed
prospectively for the onset of neurological disorders. Multiple methods of case
finding were used to maintain accuracy. The age- and sex-adjusted incidence rates
of neurological disorders were calculated. The lifetime prevalence of
neurological disorders was surveyed in 27 658 of the patients. The age- and
sex-adjusted incidence rates were calculated for major neurological conditions.
[These are expressed as rates per 100 000 persons per annum, with 95% confidence
intervals (CI) in parentheses]. The commonest of these were first cerebrovascular
events, 205 (CI: 183, 230); shingles, 140 (CI: 104, 184); diabetic
polyneuropathy, 54 (CI: 33, 83); compressive neuropathies, 49 (CI: 39, 61);
epilepsy, 46 (CI: 36, 60); Parkinson's disease, 19 (CI: 12, 27); peripheral
neuropathies, 15 (CI: 9, 23); CNS infections, 12 (CI: 5, 13); post-herpetic
neuralgia, 11 (CI: 6, 17); and major neurological injuries, 10 (CI: 4, 11).
Lifetime prevalence rates are also reported (expressed as rate per 1000 persons
with 95% CI). The most prevalent conditions were: completed stroke, 9 (CI: 8,
11); transient ischaemic attacks, 5 (CI: 4, 6); active epilepsy, 4 (CI: 4, 5);
congenital neurological deficit, 3 (CI: 3, 4); Parkinson's disease, 2 (CI: 1, 3);
multiple sclerosis, 2 (CI: 2, 3); diabetic polyneuropathy, 2 (CI: 1, 3);
compressive mononeuropathies, 2 (CI: 2, 3); and sub-arachnoid haemorrhage, 1 (CI:
0.8, 2). Overall, the onset of 625 neurological disorders was observed per 100
000 population annually. Six percent of the population had at some time had a
neurological disorder. This is the first study of the incidence and lifetime
prevalence of neurological disorders in recent times; we found that these
disorders give rise to significant morbidity in the community.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 10733998 [PubMed - indexed for MEDLINE]
281: Eur J Pain. 1999 Dec;3(4):335-342.
The lifetime occurrence of Herpes zoster and prevalence of post-herpetic
neuralgia: A retrospective survey in an elderly population.
Bowsher D.
Pain Research Institute, Walton Hospital, Liverpool, L9 1AE, UK
One-thousand-and-seventy-one randomly chosen elderly persons (537 women, 534 men;
median age 80) were recruited from the Institute of Human Aging (Dept of
Psychiatry, University of Liverpool). Almost a quarter (23.8%; equal numbers of
both sexes) had had shingles (HZ), at a median age of 60 (for both sexes); 39
subjects (3.6% of all respondents, 15% of those who had had shingles), two thirds
of whom were female, developed post-herpetic neuralgia (PHN), defined as pain
persisting for more than 3 months; they acquired HZ at a median age of 70. In 22
of them, pain had resolved by the time they were questioned, but in 17 it was
ongoing (from less than 12 to 504 months). Two new independent risk factors for
PHN were identified: (1) female gender; and (2) living alone at the time of HZ
acquisition (p = 0.009). In addition to confirming the well-known factor of: (3)
age at shingles acquisition (up to the early 90s); and (4) scarring, presumed to
be a consequence of rash severity, was significantly commoner in subjects whose
HZ was followed by PHN.Extrapolating the prevalence figures to the whole UK
population, of whom 9.28 million were over 64 in 1992, it can be conservatively
estimated that at any one time, some 200 000 people in the UK have PHN. Copyright
1999 European Federation of Chapters of the International Association for the
Study of Pain.
PMID: 10700361 [PubMed - as supplied by publisher]
282: Adv Wound Care. 1999 Jun;12(5):254-62.
Identification and treatment of herpes lesions.
Chandrasekar PH.
Department of Medicine, Wayne State University, Detroit, MI, USA.
Infections caused by the herpes family of viruses are on the rise. Mucocutaneous
herpes infections are caused by herpes simplex viruses 1 and 2 and
varicella-zoster virus. Herpes simplex virus commonly causes oral-labial or
genital infection, and varicella-zoster virus causes chicken pox and shingles.
Clinical features frequently are atypical, particularly in compromised patients.
Therefore, a high index of suspicion must be maintained for early diagnosis.
Availability of easy-to-perform rapid diagnostic tests and several potent
antiherpetic agents have vastly improved the management of herpes infections.
Publication Types:
Case Reports
Review
PMID: 10655799 [PubMed - indexed for MEDLINE]
283: Mayo Clin Health Lett. 2000 Jan;18(1):4.
New skin patch calms pain following shingles.
[No authors listed]
Publication Types:
News
PMID: 10646332 [PubMed - indexed for MEDLINE]
284: Arch Virol. 1999;144(11):2161-72.
Identification and characterization of the simian varicella virus uracil DNA
glycosylase.
Ashburn CV, Gray WL.
Department of Microbiology and Immunology, University of Arkansas for Medical
Science, Little Rock, Arkansas 72205, USA.
Simian varicella virus (SVV) infection of non-human primates is used as a model
to study the pathogenesis and latency of varicella-zoster virus (VZV), the
etiological agent of chickenpox and shingles. Uracil DNA glycosylase (UDG) is a
DNA repair enzyme responsible for excision of uracil residues misincorporated
into DNA. UDG is conserved throughout the herpesvirus family and may play an
important role in viral pathogenesis. This study identified a 300 amino acid SVV
UDG that shares 53.9% amino acid identity with the VZV UDG. The SVV UDG is
expressed in infected Vero cells as determined by reverse transcriptase
polymerase chain reaction (RT-PCR) and Northern blot analysis. The SVV UDG is
encoded on a 2.0 kb transcript which also appears to encode the SVV glycoprotein
L (gL) and the VZV gene 58 homolog. The SVV UDG is enzymatically active as
determined by the ability of a SVV UDG-maltose binding protein fusion construct
to remove [(3)H]-uracil incorporated into DNA.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 10603170 [PubMed - indexed for MEDLINE]
285: Contrib Microbiol. 1999;3:111-27.
Shingles (zoster).
Lilie HM, Wassilew SW.
Dermatologische Klinik, Klinikum Krefeld, Deutschland. lilie@klinikum-krefeld.de
Publication Types:
Review
PMID: 10599525 [PubMed - indexed for MEDLINE]
286: 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.
Publication Types:
Historical Article
Research Support, Non-U.S. Gov't
PMID: 10520948 [PubMed - indexed for MEDLINE]
287: 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
Publication Types:
English Abstract
Review
PMID: 10518396 [PubMed - indexed for MEDLINE]
288: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 10504152 [PubMed - indexed for MEDLINE]
289: J Am Acad Dermatol. 1999 Aug;41(2 Pt 2):309-11.
Shingles developing within recent surgical scars.
Nikkels AF, PiГ©rard GE.
Department of Dermatopatholgy, University Medical Center of LiГЁge, Belgium.
Occurrence of varicella and recurrence of herpes simplex on traumatized sites of
the skin are well-described events. By contrast, herpes zoster occurring
specifically at the site of previously injured skin has not yet been reported.
Two patients are presented who developed shingles limited to skin on and around
recent surgical scars. Varicella zoster virus was identified using
immunohistochemistry on skin biopsy specimens and Tzanck smears. We suspect that
the occurrence of herpes zoster involving surgical scars is usually misdiagnosed
and therefore unrecognized. Whether shingles adjacent to scars represents a
coincidental event or is specifically triggered by local injury is unknown.
Publication Types:
Case Reports
Research Support, Non-U.S. Gov't
PMID: 10426916 [PubMed - indexed for MEDLINE]
290: J Am Acad Dermatol. 1999 Jul;41(1):1-14; quiz 15-6.
Varicella zoster virus.
McCrary ML, Severson J, Tyring SK.
Section of Dermatology, Medical College of Georgia, Augusta, USA.
Because of its ability to produce two clinically distinct disease entities
(chickenpox and shingles), varicella zoster virus (VZV) is an unusual etiologic
agent. Although in the past viral exanthems were mostly only of academic interest
to the practitioner, the development of antiviral agents and the newly approved
varicella (OKA) vaccine have increased the clinical significance. Also, with the
increasing seroprevalence of HIV infection, more patients will be stricken with
zoster (at a younger age) and disseminated varicella. In this review, the
history, incidence, pathogenesis, clinical manifestations, and treatment options
(of VZV infection and postherpetic neuralgia) will be discussed.
Publication Types:
Review
PMID: 10411403 [PubMed - indexed for MEDLINE]
291: Rev Med Liege. 1999 Feb;54(2):71-5.
[Drug clinics. How I treat zona]
[Article in French]
Nikkels AF, PiГ©rard GE.
Service de Dermatopathologie, UniversitГ© de LiГЁge.
The treatment of herpes zoster relies on the intravenous or oral administration
of antiviral drugs. Oral aciclovir for shingles is hindered by its low
bioavailability. New antiviral drugs with improved oral bioavailability
(famciclovir and valaciclovir) allow a better efficacy. The opportuneness of
treating herpes zoster is different in the immunocompetent and immunocompromised
patients, and during childhood and pregnancy.
Publication Types:
English Abstract
PMID: 10221057 [PubMed - indexed for MEDLINE]
292: Drugs. 1999 Feb;57(2):187-206.
Current pharmacological approaches to the therapy of varicella zoster virus
infections: a guide to treatment.
Snoeck R, Andrei G, De Clercq E.
Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium.
robert.snoeck@rega.kuleuven.ac.be
Varicella zoster virus (VZV), a member of the herpesvirus family, is responsible
for both primary (varicella, chickenpox) as well as reactivation (zoster,
shingles) infections. In immunocompetent patients, the course of varicella is
generally benign. For varicella zoster, post-herpetic neuralgia is the most
common complication. In immunocompromised patients (particularly those with
AIDS), transplant recipients and cancer patients, VZV infections can be
life-threatening. For these patients and also for immunocompetent patients at
risk such as pregnant women or premature infants, the current treatment of choice
is based on either intravenous or oral aciclovir (acyclovir). The low oral
bioavailability of aciclovir, as well as the emergence of drug-resistant virus
strains, have stimulated efforts towards the development of new compounds for the
treatment of individuals with VZV infections. Among these new compounds,
penciclovir, its oral prodrug form famciclovir and the oral pro-drug form of
aciclovir (valaciclovir), rank among the most promising. As with aciclovir
itself, all of these drugs are dependent on the virus-encoded thymidine kinase
(TK) for their intracellular activation (phosphorylation), and, upon conversion
to their triphosphate form, they act as inhibitors/alternative substrate of the
viral DNA polymerase. Therefore, cross-resistance to these drugs may be expected
for those virus mutants that are TK-deficient and thus resistant to aciclovir.
Other classes of nucleoside analogues dependent for their phosphorylation on the
viral TK that have been pursued for the treatment of VZV infections include
sorivudine, brivudine, fialuridine, fiacitabine and netivudine. Among
oxetanocins, which are partially dependent on viral TK, lobucavir is now under
clinical evaluation. Foscarnet, which does not require any previous metabolism to
interact with the viral DNA polymerase, is used in the clinic when TK-deficient
VZV mutants emerge during aciclovir treatment. TK-deficient mutants are also
sensitive to the acyclic nucleoside phosphonates (i.e.
[s]-1-[3-hydroxy-2-phosphonylmethoxypropyl]cytosine; HPMPC); these agents do not
depend on the virus-encoded TK for their phosphorylation but depend on cellular
enzymes for conversion to their diphosphoryl derivatives which then inhibit viral
DNA synthesis. Vaccination for VZV has now come of age. It is recommended for
healthy children, patients with leukaemia, and patients receiving
immunosuppressive therapy or those with chronic diseases. The protection induced
by the vaccine seems, to some extent, to include zoster and associated neuralgia.
Passive immuniatin based on specific immunoglobulins does not effectively prevent
VZV infection and is therefore restricted to high risk individuals (i.e.
immunocompromised children and pregnant women).
Publication Types:
Review
PMID: 10188760 [PubMed - indexed for MEDLINE]
293: Br J Haematol. 1999 Mar;104(3):560-8.
Infections in adults undergoing unrelated donor bone marrow transplantation.
Williamson EC, Millar MR, Steward CG, Cornish JM, Foot AB, Oakhill A, Pamphilon
DH, Reeves B, Caul EO, Warnock DW, Marks DI.
Department of Microbiology, Bristol Royal Infirmary.
This study retrospectively reviews infections over a 7-year period in 60
consecutive adults (median age 25 years) undergoing their first unrelated donor
bone marrow transplant (UD-BMT). T-cell depletion was employed in 93%. More than
half the patients had one or more severe, potentially life-threatening,
infections. There was a high incidence of invasive fungal infections (Aspergillus
17, Candida four), despite the use of itraconazole or amphotericin prophylaxis.
Ten Aspergillus infections occurred beyond 100 d. Two patients (11%) with
invasive aspergillosis survived. Clustering of infections was noted, with
invasive fungal infections significantly associated with bacteraemias (OR 3.73,
P=0.06) and multiple viral infections (OR 4.25, P=0.05). There were 21 severe
viral infections in 16 patients, with CMV disease occurring in four patients
only; viral pneumonitis was predominantly due to 'community respiratory' viruses.
Most early bacteraemias (68%) were due to Gram-positive organisms. The majority
of episodes of Gram-negative sepsis were caused by non-fastidious
non-fermentative bacteria, such as Pseudomonas spp. and Acinetobacter spp.,
historically regarded as organisms of low pathogenicity. In patients with
successful engraftment and minimal graft-versus-host disease, late infections
suggestive of continued immune dysfunction (shingles, recurrent lower respiratory
infections, Salmonella enteritis and extensive warts) were common.
PMID: 10086795 [PubMed - indexed for MEDLINE]
294: 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.
Publication Types:
Case Reports
PMID: 10022640 [PubMed - indexed for MEDLINE]
295: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 9989948 [PubMed - indexed for MEDLINE]
296: Health News. 1999 Jan 5;5(1):1-2.
Pain after shingles.
[No authors listed]
Publication Types:
Review
PMID: 9932537 [PubMed - indexed for MEDLINE]
297: J Pediatr Gastroenterol Nutr. 1999 Jan;28(1):54-8.
Comment in:
J Pediatr Gastroenterol Nutr. 1999 Jan;28(1):17-8.
Experiences with 6-mercaptopurine and azathioprine therapy in pediatric patients
with severe ulcerative colitis.
Kader HA, Mascarenhas MR, Piccoli DA, Stouffer NO, Baldassano RN.
Division of Gastroenterology and Nutrition, The Children's Hospital of
Philadelphia, Pennsylvania 19104, USA.
BACKGROUND: The effectiveness of 6-mercaptopurine combined with azathioprine in
treating severe ulcerative colitis has been shown in several adult studies.
Reported pediatric experiences are rare. The purpose of this study was to
investigate the safety and the potential efficacy of 6-mercaptopurine and
azathioprine in the treatment of active ulcerative colitis in a pediatric
population. METHODS: The medical records of patients with active ulcerative
colitis who were under observation at The Children's Hospital of Philadelphia and
its satellite clinics from January 1984 through December 1997 were
retrospectively reviewed. Patients were included who had received a diagnosis of
ulcerative colitis, who met no criteria for Crohn's colitis, and who had received
treatment with 6-mercaptopurine and azathioprine. They were then analyzed for the
development of side effects, the indication to use 6-mercaptopurine and
azathioprine, and the ability to discontinue corticosteroid use in those patients
taking 5-acetylsalicylic acid products who were corticosteroid-dependent or whose
disease was refractory to treatment. Excluded from the corticosteroid analyses
were patients who underwent surgery for their disease and patients treated with
5-acetylsalicylic acid only. Statistical analysis was performed by the
Kaplan-Meier survival curve and paired Student's t-test. RESULTS: In a review of
200 medical records of patients with active ulcerative colitis, 20 patients met
the criteria. The patients' average age at the initiation of treatment with
6-mercaptopurine and azathioprine was 13.8 years. Sixteen patients (80%) were
corticosteroid dependent and 3 (15%) had ulcerative colitis refractory to
corticosteroid treatment. One patient had severe colitis treated with
5-acetylsalicylic acid only. Discontinuation of corticosteroid was accomplished
in 12 (75%) of 16 patients. The median time to discontinuation of corticosteroid
after initiation of 6-mercaptopurine and azathioprine therapy was 8.4 months.
Eight patients (67%), observed from 3 months to 65 months, have continued without
corticosteroid therapy. Side effects included pancreatitis and shingles that
resulted in discontinuation of 5-acetylsalicylic acid, leukopenia corrected by
withholding 6-mercaptopurine, and self-resolved hepatitis. CONCLUSIONS: The data
support the safety of 6-mercaptopurine and azathioprine use in the treatment of
pediatric patients with ulcerative colitis; side effects were minimal and
reversible. Eighteen (90%) of 20 patients tolerated the therapy well. The results
also show that 12 (75%) of 16 pediatric patients with ulcerative colitis will
benefit from the use of 6-mercaptopurine and azathioprine after initial
discontinuation of corticosteroid therapy. Although 6-mercaptopurine and
azathioprine may not prevent further relapses, medical management of these flares
may be less intense and may not require long-term corticosteroid use. Prospective
clinical trials in pediatric patients are necessary to delineate further the role
of 6-mercaptopurine and azathioprine in pediatric ulcerative colitis.
PMID: 9890469 [PubMed - indexed for MEDLINE]
298: 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.
Publication Types:
Review
PMID: 9850292 [PubMed - indexed for MEDLINE]
299: Plant Physiol. 1998 Dec;118(4):1447-54.
Direct measurement of calcium transport across chloroplast inner-envelope
vesicles
Roh MH, Shingles R, Cleveland MJ, McCarty RE.
Department of Biology, Johns Hopkins University, Baltimore, Maryland 21218-2685,
USA.
The initial rate of Ca2+ movement across the inner-envelope membrane of pea
(Pisum sativum L.) chloroplasts was directly measured by stopped-flow
spectrofluorometry using membrane vesicles loaded with the Ca2+-sensitive
fluorophore fura-2. Calibration of fura-2 fluorescence was achieved by combining
a ratiometric method with Ca2+-selective minielectrodes to determine pCa values.
The initial rate of Ca2+ influx in predominantly right-side-out inner-envelope
membrane vesicles was greater than that in largely inside-out vesicles. Ca2+
movement was stimulated by an inwardly directed electrochemical proton gradient
across the membrane vesicles, an effect that was diminished by the addition of
valinomycin in the presence of K+. In addition, Ca2+ was shown to move across the
membrane vesicles in the presence of a K+ diffusion potential gradient. The
potential-stimulated rate of Ca2+ transport was slightly inhibited by diltiazem
and greatly inhibited by ruthenium red. Other pharmacological agents such as
LaCl3, verapamil, and nifedipine had little or no effect. These results indicate
that Ca2+ transport across the chloroplast inner envelope can occur by a
potential-stimulated uniport mechanism.
PMID: 9847120 [PubMed - as supplied by publisher]
300: JAMA. 1998 Dec 2;280(21):1837-42.
Comment in:
JAMA. 1998 Dec 2;280(21):1863-4. JAMA. 1999 Jul 14;282(2):134-5.
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.
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.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 9846778 [PubMed - indexed for MEDLINE]
301: Ugeskr Laeger. 1998 Nov 23;160(48):6943.
[Treatment of chickenpox and shingles]
[Article in Danish]
Gerstoft J.
Publication Types:
Editorial
PMID: 9846086 [PubMed - indexed for MEDLINE]
302: 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.
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 9818935 [PubMed - indexed for MEDLINE]
303: 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.
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 9743315 [PubMed - indexed for MEDLINE]
304: 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.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Review
PMID: 9737826 [PubMed - indexed for MEDLINE]
305: 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.
Publication Types:
Case Reports
PMID: 9703172 [PubMed - indexed for MEDLINE]
306: 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]
307: 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.
Publication Types:
Review
PMID: 9638300 [PubMed - indexed for MEDLINE]
308: RN. 1998 May;61(5):80.
Managing the aftermath of shingles.
Scholz MJ.
Northwest Neuroscience Institute, USA.
Publication Types:
Case Reports
PMID: 9626020 [PubMed - indexed for MEDLINE]
309: 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.
Publication Types:
Case Reports
English Abstract
PMID: 9623132 [PubMed - indexed for MEDLINE]
310: 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.
PMID: 9616491 [PubMed - indexed for MEDLINE]
311: J Biol Chem. 1998 May 29;273(22):13430-6.
Intracellular transport of the glycoproteins gE and gI of the varicella-zoster
virus. gE accelerates the maturation of gI and determines its accumulation in the
trans-Golgi network.
Alconada A, Bauer U, Baudoux L, Piette J, Hoflack B.
Institut de Biologie de Lille (IFR3), Institut Pasteur de Lille, 59021 Lille,
France.
The varicella-zoster virus (VZV) is the etiological agent of two different human
pathologies, chickenpox (varicella) and shingles (zoster). This alphaherpesvirus
is believed to acquire its lipidic envelope in the trans-Golgi network (TGN).
This is consistent with previous data showing that the most abundant VZV envelope
glycoprotein gE accumulates at steady-state in this organelle when expressed from
cloned cDNA. In the present study, we have investigated the intracellular
trafficking of gI, another VZV envelope glycoprotein. In transfected cells, this
protein shows a very slow biosynthetic transport to the cell surface where it
accumulates. However, upon co-expression of gE, gI experiences a dramatic
increase in its exit rate from the endoplasmic reticulum, it accumulates in a
sialyltransferase-positive compartment, presumably the TGN, and cycles between
this compartment and the cell surface. This differential behavior results from
the ability of gE and gI to form a complex in the early stages of the
biosynthetic pathway whose intracellular traffic is exclusively determined by the
sorting information in the tail of gE. Thus, gI provides the first example of a
molecule localized to the TGN by means of its association with another TGN
protein. We also show that, during the early stages of VZV infection, both
proteins are also found in the TGN of the host cell. This suggests the existence
of an intermediate stage during VZV biogenesis in which the envelope
glycoproteins, transiently arrested in the TGN, could promote the envelopment of
newly synthesized nucleocapsids into this compartment and, therefore, the
assembly of infective viruses.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 9593675 [PubMed - indexed for MEDLINE]
312: Acta Virol. 1997 Oct;41(5):277-83.
Amplification and sequencing of varicella-zoster virus (VZV) gene 4: point
mutation in a VZV strain causing chickenpox during pregnancy.
Chow VT, Lim KP.
Department of Microbiology, Faculty of Medicine, National University of
Singapore, Republic of Singapore.
The varicella-zoster virus (VZV) causes chickenpox (varicella) as the primary
disease and shingles (zoster) as a recurrent manifestation of infection, both
being generally benign and self-limiting. While these infections may be severe in
adults and even life-threatening in immunosuppressed individuals, they may be
amenable to effective antiviral drugs or varicella-zoster immune globulin,
provided the treatment is administered early. The prompt diagnosis of VZV
infections may be accelerated by rapid, sensitive and specific molecular
techniques such as amplification by polymerase chain reaction (PCR) compared with
slower and more cumbersome tissue culture and serological procedures. Based on
the VZV gene 4 which encodes a transcriptional activator, primers were designed
for use in PCR to amplify a target fragment of 381 bp. Distinct diagnostic bands
were observed by agarose gel electrophoresis of PCR products of VZV strains
isolated from 11 varicella and 7 zoster patients in Singapore, as well as of the
Japanese vaccine Oka strain. The detection sensitivity of this PCR assay was
determined to be 1 pg of purified VZV DNA equivalent to about 7,000 viral DNA
copies. No target bands were amplified from negative control templates from five
related human herpes-viruses and from human DNA. The specificity of the PCR
products was ensured by direct cycle DNA sequencing, which revealed complete
identity of the 18 VZV isolates with the published European Dumas strain. The
strong sequence conservation of the target fragment renders this PCR assay highly
reliable for detecting the VZV sequence. Only one VZV strain isolated from a
patient with varicella during pregnancy exhibited a GGA to GAA point mutation at
codon 46 of gene 4, culminating in the non-conservative substitution of Ser with
Phe. The predicted secondary structure of the mutant polypeptide portrayed a
radical alteration, which may influence its function in transcriptional
activation.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 9607081 [PubMed - indexed for MEDLINE]
313: Proc Natl Acad Sci U S A. 1998 Apr 14;95(8):4658-62.
Latent varicella-zoster virus is located predominantly in neurons in human
trigeminal ganglia.
Kennedy PG, Grinfeld E, Gow JW.
Glasgow University Department of Neurology, Institute of Neurological Sciences,
Southern General Hospital National Health Service Trust, Glasgow G51 4TF, United
Kingdom.P.G.Kennedy@clinmed.gla.ac.uk
Varicella-zoster virus (VZV) is a human herpesvirus that causes varicella
(chicken pox) as a primary infection and, after a variable period of latency in
trigeminal and dorsal root ganglia, reactivates to cause herpes zoster
(shingles). Both of these conditions may be followed by a variety of neurological
complications, especially in immunocompromised individuals such as those with
human immunodeficiency virus (HIV) infection. There have been a number of
conflicting reports regarding the cellular location of latent VZV within human
ganglia. To address this controversy we examined fixed wax-embedded trigeminal
ganglia from 30 individuals obtained at autopsy, including 11 with HIV infection,
2 neonates, and 17 immunocompetent individuals, for the presence of latent VZV.
Polymerase chain reaction (PCR), in situ hybridization, and PCR in situ
amplification techniques with oligonucleotide probes and primer sequences to VZV
genes 18, 21, 29, and 63 were used. VZV DNA in ganglia was detected in 15
individuals by using PCR alone, and in 12 individuals (6 normal non-HIV and 6
positive HIV individuals, but not neonatal ganglia) by using PCR in situ
amplification. When in situ hybridization alone was used, 5 HIV-positive
individuals and only 1 non-HIV individual showed VZV nucleic acid signals in
ganglia. In all of the VZV-positive ganglia examined, VZV nucleic acid was
detected in neuronal nuclei. Only occasional nonneuronal cells contained VZV DNA.
We conclude from these studies that the neuron is the predominant site of latent
VZV in human trigeminal ganglia.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 9539794 [PubMed - indexed for MEDLINE]
314: Lakartidningen. 1998 Mar 25;95(13):1384-5.
[Are famciclovir and valaciclovir truly effective in the treatment of shingles?]
[Article in Swedish]
Liedholm H, LinnГ© AB.
Publication Types:
Letter
PMID: 9560964 [PubMed - indexed for MEDLINE]
315: J Bioenerg Biomembr. 1997 Dec;29(6):611-6.
Direct measurement of nitrite transport across erythrocyte membrane vesicles
using the fluorescent probe, 6-methoxy-N-(3-sulfopropyl) quinolinium.
Shingles R, Roh MH, McCarty RE.
Department of Biology, Johns Hopkins University, Baltimore, Maryland 21218-2685,
USA.
Nitrite was shown to quench the fluorescence of 6-methoxy-N-(3-sulfopropyl)
quinolinium (SPQ) almost twofold more than chloride. SPQ loaded inside vesicles
prepared from asolectin and isolated erythrocyte ghosts allowed for the direct
measurement of nitrite movement across these membranes. Movement of nitrite
across asolectin occurred by diffusion as HNO2 in a pH-dependent manner. By
contrast, erythrocyte ghosts had very low diffusion rates for nitrous acid.
Erythrocyte ghosts preloaded with 50 mM nitrite to quench SPQ fluorescence were
utilized to study heteroexchange with externally added anions. SPQ fluorescence
increases (becomes unquenched) with added bicarbonate and nitrate, indicating
that nitrite is moving out of the preloaded vesicles. The pH optimum for this
exchange was approximately 7.6 and exchange was inhibited by N-ethylmaleimide
(NEM) and dihydro-4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS). These
data indicate that nitrite moves across erythrocyte plasma membranes as NO2- by a
heteroexchange mechanism with other monovalent anions.
Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 9559862 [PubMed - indexed for MEDLINE]
316: 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.
Publication Types:
Review
PMID: 9497970 [PubMed - indexed for MEDLINE]
317: 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.
Publication Types:
Review
PMID: 9454005 [PubMed - indexed for MEDLINE]
318: J Epidemiol Community Health. 1997 Oct;51(5):494-501.
Physical illness and disability among elderly people in England and Wales: the
Medical Research Council Cognitive Function and Ageing Study. The Analysis Group.
Parker CJ, Morgan K, Dewey ME.
Department of Health Care, Elderly, Medical School, Queen's Medical Centre,
Nottingham.
STUDY OBJECTIVE: This study was conducted as part of the MRC cognitive function
and ageing study. It aimed to estimate the lifetime prevalence of self reported
physical illnesses and other health related events, and the prevalence of
limiting disability in people over 65 in six areas of England and Wales. DESIGN:
Screening phase of a two stage prevalence study. SETTING: Geographically
delimited areas in four urban and two rural areas including institutions.
PARTICIPANTS: Random population samples of people in their 65th year and above on
the sample definition date, interviewed between 1989 and 1994. In Newcastle,
Nottingham, and Oxford (urban) and in Cambridgeshire and Gwynedd(rural), the
sample was stratified to provide equal numbers in the 65-74 and 75 years and over
age groups. In Liverpool (urban), equal numbers in the five year age groups were
taken. MAIN RESULTS: Age standardised prevalences were calculated for each
geographical area, sex, and age group (65-74, 75+). Many conditions were more
prevalent in the older age group including stroke, Parkinson's disease,
arthritis, diabetes, and shingles but hypertension was more common in the younger
age group. Conditions that were more prevalent in men included angina, heart
attack, stroke, head injury, and peptic ulcers while hypertension, shingles,
pernicious anaemia, and thyroid disease were more common in women. There was a
complex pattern of area differences for individual conditions. Cambridgeshire had
generally low prevalences for many diseases, including vascular problems, Gwynedd
and Newcastle had less healthy elderly populations, and Nottingham and Newcastle
had the highest percentages of housebound. CONCLUSIONS: This study provides the
most robust available estimates for life-time prevalence of a variety of health
conditions on a regional and national basis. It shows the greatly increased
prevalence of disability in the very old population, particularly women.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 9425458 [PubMed - indexed for MEDLINE]
319: J Virol. 1998 Jan;72(1):42-7.
Varicella-zoster virus gene 21: transcriptional start site and promoter region.
Cohrs RJ, Barbour M, Gilden DH.
Department of Neurology, University of Colorado Health Sciences Center, Denver
80262, USA. randall.cohrs@uchsc.edu
Varicella-zoster virus (VZV) causes chicken pox (varicella), becomes latent in
dorsal root ganglia, and reactivates decades later to cause shingles (zoster).
During latency, the entire VZV genome is present in a circular form, from which
genes 21, 29, 62, and 63 are transcribed. Immediate-early (IE) VZV genes 62 and
63 encode regulators of virus gene transcription, and VZV gene 29 encodes a major
DNA-binding protein. However, little is known about the function of VZV gene 21
or the control of its transcription. Using primer extensions, we mapped the start
of VZV gene 21 transcription in VZV-infected cells to a single site located at
-79 nucleotides (nt) with respect to the initiation codon. To identify the VZV
gene 21 promoter, the 284-bp region of VZV DNA separating open reading frames
(ORFs) 20 and 21 was cloned upstream from the chloramphenicol acetyltransferase
gene. In transient-transfection assays, the VZV gene 21 promoter was
transactivated in VZV-infected, but not uninfected, cells. Further, the protein
encoded by ORF 62 (IE62), but not those encoded by VZV ORFs 4, 10, 61, and 63,
transactivates the VZV gene 21 promoter. By use of transient-cotransfection
assays in conjunction with 5' deletions of the VZV gene 21 promoter, a 40-bp
segment was shown to be responsible for the transactivation of the VZV gene 21
promoter by IE62. This region was located at -96 to -56 nt with respect to the 5'
start of gene 21 transcription.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 9420198 [PubMed - indexed for MEDLINE]
320: 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]
321: Clin Orthop Relat Res. 1997 Oct;(343):224-34.
Displacements of the tibial tuberosity. Effects of the surgical parameters.
Benvenuti JF, Rakotomanana L, Leyvraz PF, Pioletti DP, Heegaard JH, Genton MG.
HГґpital OrthopГ©dique de la Suisse Romande, Lausanne, Switzerland.
A three-dimensional computer model is used, based on the finite element method,
to investigate the effects of 1-, 1.5-, and 2-cm tibial tubercle elevations and
of 0.5- and 1-cm medial displacements of the tuberosity, performed with different
bone shingles. Patellar kinematics and patellofemoral interface peak pressure,
between 45 degrees and 135 degrees of passive knee flexion, are compared for
these different surgical parameters with those of a normal knee not surgically
treated. The shingle lengths of 3, 5, 7, and 10 cm have little influence on the
results. Augmenting tubercle medializations decrease the lateral peak pressure
but result in an overpressure of the medial facet that is 154% of the normal peak
value. With knee flexion between 45 degrees and 60 degrees, increasing tubercle
elevations decreases later and medial peak pressures. With flexion of more than
60 degrees, increasing elevations decrease the lateral peak pressure, but they
augment and even cause overpressure on the medial facet. An overpressure on the
lateral facet also is seen in midrange knee flexion (75 degrees-90 degrees) for
all tubercle elevation values. Increasing tubercle elevations and medializations
appear to be the predominant parameters from a biomechanical point of view.
Publication Types:
Comparative Study
PMID: 9345228 [PubMed - indexed for MEDLINE]
322: Anal Biochem. 1997 Oct 1;252(1):190-7.
Measurement of carbonic anhydrase activity using a sensitive fluorometric assay.
Shingles R, Moroney JV.
Department of Biology, The Johns Hopkins University, Baltimore, Maryland
21218-2685, USA.
The dehydration reaction of bicarbonate was measured using the fluorescent pH
indicator, 8-hydroxypyrene-1,3,6-trisulfonate (pyranine), in combination with
stopped-flow spectrofluorometry. The initial rate of bicarbonate dehydration was
measured after mixing a pH 6.0 solution with a pH 8.0 solution containing
bicarbonate. Addition of carbonic anhydrase to the pH 6.0 solution enabled the
measurement of the initial rate of activity at physiological temperatures with
resolution times of 2 ms. This assay was used to resolve differences in activity
and sensitivity to sulfonamides by comparing mammalian carbonic anhydrase
isoforms. The fluorescent technique used in this study is very sensitive,
allowing the determination of initial rates with a protein concentration as
little as 65 ng/ml. Pyranine can also be loaded into membrane vesicles to follow
carbonic anhydrase activity within vesicles. The change in pH within vesicles is
dependent on the concentration of externally added bicarbonate and the presence
of carbonic anhydrase on either side of the membrane. Therefore, this assay can
be used to measure carbon dioxide flux across membranes and to assess the
contribution of carbonic anhydrase to this flux.
Publication Types:
Comparative Study
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 9324959 [PubMed - indexed for MEDLINE]
323: Clin Chem. 1997 Oct;43(10):1843-9.
Quantitative polymerase chain reaction for human herpesvirus diagnosis and
measurement of Epstein-Barr virus burden in posttransplant lymphoproliferative
disorder.
Bai X, Hosler G, Rogers BB, Dawson DB, Scheuermann RH.
Department of Pathology, University of Texas Southwestern Medical Center, Dallas
75235-9072, USA.
Human herpesviruses can cause acute diseases such as chicken pox or
mononucleosis, but also may reactivate during immunosuppression and result in
severe or life-threatening illnesses such as shingles or lymphoproliferative
disorders. We report the development and validation of a quantitative PCR method
to measure viral burden for all eight human herpesviruses (HSV1, HSV2, VZV, EBV,
CMV, HHV6, HHV7, and KSHV) in patients' samples. The method uses an internal
standard that is coamplified with the viral target, allowing quantification of
viral genomes in absolute terms (e.g., viral targets/mL of blood) and ruling out
false-negative results. We demonstrate that transplant patients with
lymphoproliferative disorder carry an EBV viral burden 3 logs higher than
nontransplant patients. EBV titers in transplant patients without a
lymphoproliferative disorder are between these values. This quantitative PCR
method may aid in differentiating clinically significant vs latent viral burden
in immunosuppressed patients.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 9342002 [PubMed - indexed for MEDLINE]
324: Postgrad Med. 1997 Oct;102(4):125-6, 129-35, 139-40.
Preventing and treating major opportunistic infections in AIDS. What's new and
what's still true.
Cavert W.
University of Minnesota Delaware Street (HIV) Clinic, Minneapolis, USA.
winston@lenti.med.umn.edu
New highly active antiretroviral therapies are boosting the blood absolute CD4+
counts of many patients with AIDS and are decreasing the prevalence of
AIDS-related opportunistic infections. Nevertheless, the prevention, diagnosis,
and treatment of opportunistic infections remain important features of management
of HIV infection. In recent years, significant advances have been made in the
prevention and treatment of opportunistic diseases such as Pneumocystis carinii
pneumonia, Cytomegalovirus retinitis, disseminated Mycobacterium
avium-intracellulare infection, and mucosal candidiasis. Tuberculosis,
cryptococcal meningitis, herpes simplex virus infection, shingles, and infectious
enteritis also continue to be troublesome. Kaposi's sarcoma may be the newest
AIDS-related opportunistic infection to be identified. The immune system effects
of highly active antiretroviral therapy are as yet poorly understood. Therefore,
an aggressive approach to diagnosis and treatment of opportunistic infections
remains mandatory, and patients receiving antiretroviral therapy should continue
to adhere to recommendations for prophylaxis against such infections.
Publication Types:
Review
PMID: 9336601 [PubMed - indexed for MEDLINE]
325: 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.
Publication Types:
Comparative Study
PMID: 9298733 [PubMed - indexed for MEDLINE]
326: J Altern Complement Med. 1997 Summer;3(2):155-8.
Successful treatment of herpetic infections by autohemotherapy.
Olwin JH, Ratajczak HV, House RV.
Rush Presbyterian St. Luke's Medical Center, Chicago, IL, USA.
Herpes zoster (shingles) affects a significant number of individuals over age 50.
To date, no satisfactory treatment has been available. The clinician author (JHO)
witnessed a dramatic response of a shingles patient to autohemotherapy: the pain
was completely relieved and lesions gone within 5 days with no recurrence of
either. Treatment of other herpetic patients then began with autohemotherapy.
Twenty-five patients with herpes were given an autologous blood transfer of 10 mL
of blood from the antecubital vein into the gluteal bundle and followed for
clinical signs. A 100% favorable response occurred in 20 patients who received
autohemotherapy within 7 weeks of the onset of clinical signs and 1 other who
received autohemotherapy at a 9-week interval. No untoward signs or symptoms of
the treatment occurred. Autohemotherapy has been demonstrated to be effective in
elimination of clinical sequelae in these cases of herpes infections and these
results justify further rigorous clinical investigation.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 9395705 [PubMed - indexed for MEDLINE]
327: 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]
328: 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.
Publication Types:
Comparative Study
Research Support, U.S. Gov't, P.H.S.
PMID: 9098175 [PubMed - indexed for MEDLINE]
329: Am J Epidemiol. 1997 Apr 1;145(7):581-93.
Familial and personal medical history of cancer and nervous system conditions
among adults with glioma and controls.
Wrensch M, Lee M, Miike R, Newman B, Barger G, Davis R, Wiencke J, Neuhaus J.
Department of Epidemiology and Biostatistics, School of Medcine, University of
California, San Francisco 94143-0560, USA.
The causes of glioma, the most common type of primary malignant brain tumor, are
poorly understood. This study compared the personal and first-degree familial
medical histories of 462 adults newly diagnosed with glioma in the San Francisco
Bay Area between August 1, 1991, and March 31, 1994, with those of 443 controls
who were frequency-matched on age, sex, and ethnicity. Cases and controls had
equivalent personal histories of cancers other than brain cancer and most nervous
system conditions, but they differed significantly regarding histories of
epilepsy, seizures, or convulsions 3 or more years prior to diagnosis (odds ratio
= 3.3, 95% confidence interval (CI) 1.4-7.9), chickenpox (odds ratio = 0.4, 95%
CI 0.3-0.6), and shingles (odds ratio = 0.5, 95% CI 0.3-0.8). Four cases (less
than 1%) and no controls had known genetic disorders (three had neurofibromatosis
and one had tuberous sclerosis). Cases and controls had similar family histories
of cancer and seizures. However, the odds ratio for a validated family history of
primary brain tumor was 2.3 (95% CI 1.0-5.8). These results suggest that although
family history of any cancer probably is not an important risk factor for adult
glioma, a family history of brain tumors may play a role. Variation in exposure
to or biologic response to common viral infections might play a greater role in
the etiology of adult glioma than family history.
Publication Types:
Comparative Study
Research Support, U.S. Gov't, P.H.S.
PMID: 9098174 [PubMed - indexed for MEDLINE]
330: Proc Natl Acad Sci U S A. 1997 Apr 1;94(7):2874-9.
Crystal structure of varicella-zoster virus protease.
Qiu X, Janson CA, Culp JS, Richardson SB, Debouck C, Smith WW, Abdel-Meguid SS.
Department of Macromolecular Sciences, SmithKline Beecham Pharmaceuticals, King
of Prussia, PA 19406, USA.
Varicella-zoster virus (VZV), an alpha-herpes virus, is the causative agent of
chickenpox, shingles, and postherpetic neuralgia. The three-dimensional crystal
structure of the serine protease from VZV has been determined at 3.0-A
resolution. The VZV protease is essential for the life cycle of the virus and is
a potential target for therapeutic intervention. The structure reveals an overall
fold that is similar to that recently reported for the serine protease from
cytomegalovirus (CMV), a herpes virus of the beta subfamily. The VZV protease
structure provides further evidence to support the finding that herpes virus
proteases have a fold and active site distinct from other serine proteases. The
VZV protease catalytic triad consists of a serine and two histidines. The distal
histidine is proposed to properly orient the proximal histidine. The
identification of an alpha-helical segment in the VZV protease that was mostly
disordered in the CMV protease provides a better definition of the postulated
active site cavity and reveals an elastase-like S' region. Structural differences
between the VZV and CMV proteases also suggest potential differences in their
oligomerization states.
PMID: 9096314 [PubMed - indexed for MEDLINE]
331: 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.
Publication Types:
Case Reports
PMID: 9084199 [PubMed - indexed for MEDLINE]
332: Pharmacoeconomics. 1997 Mar;11(3):262-73.
Economic evaluation of antiviral therapy for the treatment of herpes zoster in
immunocompetent adults.
GrГјger 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.
Publication Types:
Clinical Trial
Multicenter Study
Randomized Controlled Trial
PMID: 10165315 [PubMed - indexed for MEDLINE]
333: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 9015277 [PubMed - indexed for MEDLINE]
334: Arch Ophthalmol. 1996 Dec;114(12):1481-5.
Erratum in:
Arch Ophthalmol 2000 Apr;118(4):543. Arrevalo JF [corrected to Arevalo JF].
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.
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.
Publication Types:
Case Reports
PMID: 8953979 [PubMed - indexed for MEDLINE]
335: Plant Physiol. 1996 Nov;112(3):1375-1381.
Nitrite Transport in Chloroplast Inner Envelope Vesicles (I. Direct Measurement
of Proton-Linked Transport).
Shingles R, Roh MH, McCarty RE.
Department of Biology, Johns Hopkins University, Baltimore, Maryland 21218-2685.
Chloroplast inner envelope membrane vesicles that are loaded with the
pH-sensitive fluorophore, pyranine, show rapid internal acidification when
nitrite is added. Acidification is dependent upon [delta]pH, with the inside of
vesicles being alkaline with respect to the outside. The rate of vesicle
acidification was directly proportional to the concentration of nitrite that was
added and the imposed pH difference across the membrane. In contrast, added
nitrate had no effect on vesicle acidification. Nitrite also caused acidification
of asolectin vesicles. The extent of vesicle acidification is dependent on the
internal volume of vesicles. Inner envelope and asolectin vesicles that were
prepared by extrusion were approximately the same size, allowing them to be
compared when the final extent of acidification, measured after the pH gradient
had collapsed, was similar. The rate of nitrite-dependent acidification was
similar in these two preparations at any single nitrite concentration. These
results indicate that nitrite movement occurs by rapid diffusion across membranes
as nitrous acid, and this movement is dependent on a proton gradient across the
lipid bilayer. Under conditions approximating those in vivo, the rate of
diffusion of nitrous acid far exceeds that of nitrite reduction within
chloroplasts.
PMID: 12226452 [PubMed - as supplied by publisher]
336: 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 LiГЁge, 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 9010998 [PubMed - indexed for MEDLINE]
337: 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]
338: 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.
Publication Types:
Review
PMID: 8899447 [PubMed - indexed for MEDLINE]
339: Practitioner. 1996 Sep;240(1566):552.
Shingles.
Wyndham M.
British Society for the Study of Infection.
Publication Types:
Review
PMID: 8984465 [PubMed - indexed for MEDLINE]
340: 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.
Publication Types:
Case Reports
PMID: 8886539 [PubMed - indexed for MEDLINE]
341: 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,
MГјnchen.
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.
Publication Types:
Case Reports
English Abstract
Review
PMID: 8805107 [PubMed - indexed for MEDLINE]
342: Hosp Pract (Minneap). 1996 Jul 15;31(7):137-44.
Comment in:
Hosp Pract (Minneap). 1996 Oct 15;31(10):42.
Early treatment of herpes zoster.
Tyring SK.
Department of Dermatology, University of Texas Medical Branch at Galveston, USA.
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.
Publication Types:
Case Reports
Review
PMID: 8682880 [PubMed - indexed for MEDLINE]
343: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 8692974 [PubMed - indexed for MEDLINE]
344: 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.
Publication Types:
Review
PMID: 8809466 [PubMed - indexed for MEDLINE]
345: 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.
Publication Types:
Review
PMID: 8840410 [PubMed - indexed for MEDLINE]
346: J Paediatr Child Health. 1996 Jun;32(3):211-7.
Acyclovir for the prevention and treatment of varicella zoster in children,
adolescents and pregnancy.
Kesson AM, Grimwood K, Burgess MA, Ferson MJ, Gilbert GL, Hogg G, Isaacs D,
Kakakios A, McIntyre P.
Australasian Society for infectious Diseases, Sydney, New South Wales, Australia.
Varicella causes a mild, self-limiting childhood disease that may reactivate
years later as shingles. In immunocompromised patients with altered cell mediated
immunity, and rarely in healthy individuals, varicella results in a
life-threatening infection. The antiviral drug, acyclovir, substantially reduces
the mortality and risk of severe disease in these groups of patients. Early
commencement of acyclovir is recommended for children with both varicella and
altered cell mediated immunity, newborns during the first 2 weeks of life,
preterm infants in the neonatal nursery, and severe varicella or shingles
(including ocular zoster) in any patient, as well as during pregnancy. Acyclovir
may be considered in children with serious cardiopulmonary disease or chronic
skin disorders where varicella may exacerbate the underlying disease or increase
the risk of secondary bacterial sepsis. Acyclovir, however, is not recommended
for healthy individuals without severe disease, as a prophylactic agent against
varicella, for asthmatics receiving aerosolized or low-dose oral steroids and/or
as treatment of the post-varicella syndromes. When acyclovir is prescribed it
should be given intravenously to those with severe disease, those at risk of
dissemination and in children younger than 2 years of age.
Publication Types:
Review
PMID: 8827537 [PubMed - indexed for MEDLINE]
347: 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.
Publication Types:
Case Reports
PMID: 8806124 [PubMed - indexed for MEDLINE]
348: Cas Lek Cesk. 1996 Apr 17;135(8):244-8.
[Changes in the incidence and clinical manifestations of herpes zoster]
[Article in Czech]
CernГЅ Z.
InfekcnГ 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.
Publication Types:
English Abstract
PMID: 8689663 [PubMed - indexed for MEDLINE]
349: Mol Biotechnol. 1996 Apr;5(2):125-37.
Acyclic nucleosides as antiviral compounds.
Freeman S, Gardiner JM.
Department of Pharmacy, University of Manchester, UK.
Acyclovir is an effective drug for the treatment of HSV and VZV infections, which
after phosphorylation to the triphosphate, inhibits viral DNA polymerase.
Acyclovir has low oral bioavailability, therefore prodrugs have been developed,
and the L-valyl ester, valaciclovir, recently has been licensed for the treatment
of shingles. Ganciclovir is used against CMV, and famciclovir, a lipophilic
prodrug of penciclovir, is marketed for shingles. The acyclic nucleoside
phosphonates are active against thymidine kinase-resistant viral strains.
Promising analogs are PMEA (in clinical trial for the treatment of AIDS) and
(S)-HPMPC (good in vivo activity against HSV, VZV, CMV, and EBV).
Oligonucleotides incorporating acyclic nucleosides at the 3'-and 5'-ends, or
constituted of amino acyclic nucleosides, are resistant to cleavage by nucleases
and may be useful in antisense and/or antigene therapy. HEPT is active against
HIV-1: It binds in a hydrophic pocket on reverse transcriptase, rather than in
the polymerase active site. Some acyclic nucleosides are potent inhibitors of
purine and pyrimidine nucleoside phosphorylase. These compounds may have a
therapeutic niche in combination therapy with antiviral and anticancer
nucleosides, and in the treatment of diseases involving the T-cell.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 8734425 [PubMed - indexed for MEDLINE]
350: 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.
Publication Types:
Clinical Trial
PMID: 9182115 [PubMed - indexed for MEDLINE]
351: 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.
Publication Types:
Review
PMID: 8845591 [PubMed - indexed for MEDLINE]
352: 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.
Publication Types:
Review
PMID: 9163025 [PubMed - indexed for MEDLINE]
353: AIDS. 1996 Jan;10(1):55-60.
Comment in:
AIDS. 1996 Sep;10(11):1300-1.
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.
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.
Publication Types:
Case Reports
PMID: 8924252 [PubMed - indexed for MEDLINE]
354: 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.
Publication Types:
Review
PMID: 8905076 [PubMed - indexed for MEDLINE]
355: 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.
Publication Types:
Review
PMID: 8860354 [PubMed - indexed for MEDLINE]
356: 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.
Publication Types:
Review
PMID: 8542053 [PubMed - indexed for MEDLINE]
357: BETA. 1995 Dec;:33-7.
Herpesviruses.
Bowers M.
San Francisco AIDS Foundation, San Francisco, CA.
AIDS: The signs, symptoms, diagnoses, and treatment of human herpesviruses are
discussed, including advances and refinements in treatment options. Various
treatment drugs, such as Zovirax, Famvir, Cidofovir, Foscarnet, Valtrex, and
Virend, are examined. Genital herpes vaccines and possible alternative therapies
are reviewed. In particular, varicella zoster virus, the virus that produces
chicken pox and shingles, is examined, including its signs, symptoms, and
intervention strategies using famciclovir and sorivudine. Final comments discuss
the Epstein-Barr virus, the cause of mononucleosis, the newly discovered human
herpesviruses, and the future prospects for identifying and appropriately
treating herpesviruses.
Publication Types:
Newspaper Article
PMID: 11363008 [PubMed - indexed for MEDLINE]
358: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Review
PMID: 8545022 [PubMed - indexed for MEDLINE]
359: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 7479921 [PubMed - indexed for MEDLINE]
360: AIDS Clin Care. 1995 Oct;7(10):83-4.
HIV and family living. Preventing the spread of HIV and other diseases.
Sax P, Weinberger H.
Brigham and Women's Hospital, Boston, MA.
AIDS: HIV is spread through direct contact with body fluids, such as blood,
semen, vaginal fluids, and breast milk. HIV is not spread through everyday
contact. People with HIV are not dangerous to the people they live with at home
or in the community and with whom they have ordinary, non-sexual contact. Certain
precautions should be taken, however, to minimize risk. First, personal items
such as razors, toothbrushes or earrings, should not be shared. Latex gloves
should be worn by uninfected family members when they may come into contact with
bodily fluids, and the family members should always wash their hands with soap
and water after touching blood and other fluids, even if gloves have been worn.
The person with HIV can be protected by minimizing exposure to food-borne
illnesses carried by raw or undercooked meat, eggs or unpasteurized milk;
limiting contact with people who have colds, the flu or diarrhea; and avoiding
contact with cages or litter boxes of pets. To help clarify sanitary measures,
some frequently asked questions are answered. These questions address the safety
of sharing food with HIV-infected people; chickenpox infection and emergence of
shingles; prevention of CMV infection; toxoplasmosis and cats; spread of M. avium
complex (MAC); and the safety of contact between HIV-infected people and infants.
Publication Types:
Newspaper Article
PMID: 11362833 [PubMed - indexed for MEDLINE]
361: 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.
Publication Types:
Comparative Study
PMID: 8577631 [PubMed - indexed for MEDLINE]
362: Aust Fam Physician. 1995 Sep;24(9):1747; quiz 1747-8.
Shingles in a 63 year old woman.
[No authors listed]
Publication Types:
Case Reports
PMID: 7487662 [PubMed - indexed for MEDLINE]
363: 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.
Publication Types:
Comparative Study
Review
PMID: 8521764 [PubMed - indexed for MEDLINE]
364: Anal Biochem. 1995 Jul 20;229(1):92-8.
Production of membrane vesicles by extrusion: size distribution, enzyme activity,
and orientation of plasma membrane and chloroplast inner-envelope membrane
vesicles.
Shingles R, McCarty RE.
Department of Biology, Johns Hopkins University, Baltimore, Maryland 21218-2685,
USA.
A comparison of plasma membrane vesicles prepared by a freeze/thaw method was
made with vesicles prepared by extrusion through a 100-nm polycarbonate filter.
Based on ATPase measurements in the presence or absence of detergent, plasma
membrane vesicles were approximately 30% right-side-out in freeze/thaw vesicles,
whereas vesicles produced by extrusion were approximately 80% right-side-out.
Chloroplast inner-envelope membrane vesicles were loaded with a
membrane-impermeant, pH-sensitive fluorophore, pyranine, by either freeze/thaw or
extrusion techniques. ATP-linked proton transport activity was considerably lower
in vesicles prepared by extrusion compared to vesicles prepared by freeze/thaw.
However, total ATPase activity measured as ADP release from ATP was equivalent in
both preparations of vesicles. These results suggest that the inner-envelope
vesicles produced by extrusion were predominantly oriented right-side-out.
Inner-envelope vesicles were loaded internally with phosphate to study
proton-linked transport of 3-phosphoglycerate. Vesicle acidification by
3-phosphoglycerate addition was similar in both freeze/thaw and extruded vesicle
preparations, indicating that metabolite transport by the phosphate translocator
is both functional and bidirectional. These results indicate that extrusion can
be used as a method to produce proteoliposomes which are competent for transport
studies.
Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 8533901 [PubMed - indexed for MEDLINE]
365: Aust Fam Physician. 1995 Jun;24(6):1167-8.
Cold sores and shingles.
Holley WC.
Publication Types:
Letter
PMID: 7625954 [PubMed - indexed for MEDLINE]
366: 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]
Publication Types:
Guideline
Practice Guideline
Research Support, Non-U.S. Gov't
PMID: 7673741 [PubMed - indexed for MEDLINE]
367: J Infect Dis. 1995 Mar;171(3):701-4.
Comment in:
J Infect Dis. 1996 Jul;174(1):239-41.
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.
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.
Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
PMID: 7876622 [PubMed - indexed for MEDLINE]
368: Adolesc Med. 1995 Feb;6(1):55-64.
Varicella-Zoster Virus Infections in Adolescents.
Schutze GE, Jacobs RF.
Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72202-3591,
USA.
Adolescents are susceptible to both chickenpox and shingles, and they become more
ill and more likely to be hospitalized than younger patients infected with
varicella. Issues such as diagnosis, therapy, infection control, and prevention
are reviewed as they relate to both varicella and zoster.
PMID: 10358301 [PubMed - as supplied by publisher]
369: Br J Clin Pharmacol. 1995 Feb;39(2):143-9.
The bioavailability and disposition of
1-(beta-D-arabinofuranosyl)-5-(1-propynyl)uracil (882C87), a potent, new
anti-varicella zoster virus agent.
Peck RW, Wootton R, Lee DR, Jackson SH, Posner J.
Department of Clinical Pharmacology, Wellcome Foundation Ltd., Beckenham, Kent.
1. The bioavailability and disposition of 882C87, an anti-varicella zoster virus
(VZV) agent, have been investigated in healthy young and elderly volunteers. 2.
The mean bioavailability of a 200 mg tablet was 21.1% in the young (range
13.3-33.0%, n = 10) and 24.6% in the elderly (range 14.4-38.4%, n = 8), which is
sufficient to achieve plasma concentrations well above the IC50 for anti-VZV
activity. 3. Plasma concentrations of 882C87 after 50 mg i.v. were higher in the
elderly than in the young, associated with a significantly longer half-life (13.7
vs 11.8 h) and decreased renal clearance (0.11 vs 0.14 ml min-1 kg-1) and total
clearance (0.15 vs 0.17 ml min-1 kg-1). 4. After intravenous administration, the
main route of elimination of 882C87 was renal with 81.6% recovered unchanged in
urine in the young and 71.2% in the elderly. The pyrimidine base,
5-propynyluracil (5-PU) was unquantifiable in plasma and only present in trace
amounts in urine. 5. After oral administration to four healthy volunteers, only
17% of a dose of [14C]-882C87 was recovered unchanged in urine and 58% as 5-PU,
with total recovery in urine accounting for 86% of the dose. There was a lag of
4-12 h before the appearance of 5-PU in plasma, peak concentrations were
one-third to a half those of 882C87. The data suggest that 5-PU is formed from
unabsorbed 882C87 in the gut lumen and then absorbed and excreted in urine. 6.
882C87 is a potential once daily treatment for shingles.
Publication Types:
Clinical Trial
Comparative Study
Randomized Controlled Trial
PMID: 7742152 [PubMed - indexed for MEDLINE]
370: Nurse Pract. 1995 Jan;20(1):80.
Famciclovir approved for shingles.
[No authors listed]
Publication Types:
News
PMID: 7898796 [PubMed - indexed for MEDLINE]
371: J Infect. 1995 Jan;30(1):29-36.
Is Bell's palsy a reactivation of varicella zoster virus?
Morgan M, Moffat M, Ritchie L, Collacott I, Brown T.
Department of Medical Microbiology, Aberdeen Royal Hospitals Trust (University of
Aberdeen), Foresterhill, U.K.
Despite various pointers to an infectious aetiology, the cause of Bell's palsy
remains obscure. We examined paired sera from 62 patients with facial palsy and
50 age and sex matched contemporaneous controls. Significantly more patients than
controls had IgM antibodies by ELISA to varicella zoster virus (56.5% vs. 20%, P
= 0.0001) and herpes simplex virus (41.9% vs. 18%, P = 0.006). Additionally,
significantly more patients than controls were positive for CF antibody to
varicella zoster virus (14.5% vs. 0%, P = 0.004) but not to herpes simplex or
cytomegalovirus. Significantly more controls than patients (54% vs. 25.8%, P =
0.002) had no evidence of antigenic stimulation by any of the herpesvirus group.
No significant difference between patients and controls in seropositivity by IgM
ELISA to cytomegalovirus. Epstein-Barr virus and IFA for human herpes virus 6 was
found. Furthermore, there was no significant difference between the two groups as
to evidence of recent infection by the following agents: rubella virus and
Borrelia burgdorferi by IgM ELISA, influenza A. influenza B, adenovirus,
respiratory syncytial virus, mumps and measles. Mycoplasma pneumoniae, Coxiella
burnetii and chlamydia spp. by complement fixation test. The first reported case
of clinically and serologically proven Mycoplasma pneumoniae pneumonia associated
with Bell's palsy is described. The rate of complete recovery at 6-8 weeks after
onset was not significantly different in patients who were given steroids
compared to those who were not. Ear related symptoms were the most common,
occurring in 12 of 65 cases, but only three (4.6%) had clinical shingles
(vesicles in ear).(ABSTRACT TRUNCATED AT 250 WORDS)
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 7751662 [PubMed - indexed for MEDLINE]
372: 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, DegrГ© 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]
373: Surgery. 1994 Dec;116(6):1024-30.
Comparative analysis of complications from I-131 radioablation for
well-differentiated thyroid cancer.
DiRusso G, Kern KA.
Department of Surgery, Hartford Hospital, Conn.
BACKGROUND. The decision to extend thyroidectomy to the opposite lobe during
resection of well-differentiated thyroid cancer should include an analysis of
complications of I-131 radioablation directly related to the thyroid remnant. If
significant, then contralateral resection would be indicated. To clarify this
issue we studied the incidence of complications of I-131 radioablation in 63
cases of well-differentiated thyroid cancer. METHODS. Retrospective reviews of
operative notes, pathology reports, office records, and physician interviews were
made. We analyzed operations, complications, and radiation dosing. RESULTS.
Procedures included unilateral thyroidectomy, 10 (15.9%); subtotal thyroidectomy,
seven (11.1%); near-total thyroidectomy, 25 (39.7%); and total thyroidectomy, 21
(33.3%). The average ablative dose was 101 mCi (range, 30 to 208 mCi). Nineteen
percent (12 of 63) of patients had complications including radiation thyroiditis
(eight), chronic sialoadenitis (one), odynophagia (one), facial edema (one), and
shingles (one). Near-total or total thyroidectomy resulted in significantly fewer
complications compared with lesser resections (8.7% versus 47.1%, p < 0.005).
CONCLUSIONS. The incidence of complications of I-131 radioablation after
thyroidectomy for well-differentiated thyroid cancer is related to the extent of
thyroidectomy performed. We recommend contralateral thyroid resection (resulting
in a near-total or total thyroidectomy) in patients likely to receive
postoperative I-131 radioablation.
Publication Types:
Comparative Study
PMID: 7985082 [PubMed - indexed for MEDLINE]
374: Am J Respir Crit Care Med. 1994 Dec;150(6 Pt 1):1697-701.
Prevalence of occupational asthma among workers exposed to eastern white cedar.
Malo JL, Cartier A, L'Archeveque J, Trudeau C, Courteau JP, Bherer L.
Department of Chest Medicine, HГґpital du SacrГ©-Coeur, Montreal, Quebec, Canada.
We assessed the prevalence of occupational asthma among current (n = 29/31, 94%)
and former (n = 13/49, 27%) employees of a sawmill in which eastern white cedar
has been made into shingles during the past 3 yr. All participants answered a
respiratory questionnaire, and all except one underwent spirometry and
methacholine inhalation tests. All those with bronchial hyperresponsiveness (PC20
methacholine < or = 19 mg/ml) were invited to undergo specific inhalation
challenges. Mean duration of exposure was 13 mo (19 workers > 12 mo).
Twenty-eight workers (65%) reported a history compatible with asthma, and 25
(58%) had symptoms that were suggestive of occupational asthma. Only two subjects
had significant airway obstruction (FEV1 < 80% pred) (mean value = 98% pred).
Eighteen subjects (42%) had a PC20 < or = 16 mg/ml. Specific inhalation tests
with plicatic acid and/or western red cedar (which contains twice as much
plicatic acid as eastern white cedar), were done on 12 subjects who had a PC20 <
or = 16 mg/ml when they were assessed. Three subjects were considered to have
positive tests (one had an isolated immediate reaction, one had a late reaction,
and one had significant changes in PC20 each time he was exposed but no changes
in FEV1). Environmental monitoring showed concentrations of total dusts above 2
mg/m3 in half of the samples. The prevalence of occupational asthma in this
workplace was three of 42 participants (7%) or at least three of 80 (3.8%) of all
current or ex-workers. This is comparable to the prevalence of occupational
asthma in subjects exposed to western red cedar.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 7952635 [PubMed - indexed for MEDLINE]
375: 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)
Publication Types:
Review
PMID: 7858367 [PubMed - indexed for MEDLINE]
376: 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.
Publication Types:
Case Reports
PMID: 7829687 [PubMed - indexed for MEDLINE]
377: Plant Physiol. 1994 Oct;106(2):731-737.
Direct Measurement of ATP-Dependent Proton Concentration Changes and
Characterization of a K+-Stimulated ATPase in Pea Chloroplast Inner Envelope
Vesicles.
Shingles R, McCarty RE.
Department of Biology, The Johns Hopkins University, Baltimore, Maryland
21218-2685.
Inner envelope membrane vesicles prepared from pea (Pisum sativum L. var Laxton's
Progress No. 9) chloroplasts have K+-stimulated ATPase activity with a pH optimum
of 8.4. ATP addition to inner envelope vesicles loaded with pyranine caused a
decrease in pyranine fluorescence that was consistent with internal
acidification. The transmembrane pH change induced by the addition of 5 mM ATP
was about 0.4 unit. Measurement of phosphate released by ATP hydrolysis
paralleled the pH change, indicating that intravesicular acidification was linked
to ATPase activity. Vanadate, molybdate, N-ethylmaleimide, and dithiothreitol
inhibited ATP-dependent vesicle acidification completely, whereas ATPase activity
was only partially inhibited. These data indicate that pea chloroplast inner
envelope vesicles contain a proton translocating ATPase and that the
pyranine-loading method can be utilized to study directly ATP-dependent H+
transport across these membranes.
PMID: 12232365 [PubMed - as supplied by publisher]
378: 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.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 7942763 [PubMed - indexed for MEDLINE]
379: Am J Hosp Pharm. 1994 Oct 1;51(19):2326.
Famciclovir released for shingles treatment.
[No authors listed]
Publication Types:
Comparative Study
News
PMID: 7847396 [PubMed - indexed for MEDLINE]
380: Drugs. 1994 Oct;48(4):528-48.
Recognition and treatment of shingles.
Nikkels AF, PiГ©rard GE.
Department of Dermatopathology, University of LiГЁge, 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.
Publication Types:
Review
PMID: 7528128 [PubMed - indexed for MEDLINE]
381: 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.
Publication Types:
Case Reports
English Abstract
PMID: 7940450 [PubMed - indexed for MEDLINE]
382: 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)
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 10147439 [PubMed - indexed for MEDLINE]
383: J Can Dent Assoc. 1994 May;60(5):439-40.
Dr. Helene Shingles: a life dedicated to geriatric dentistry.
Crawford PR.
Publication Types:
Biography
Historical Article
Personal Name as Subject:
Shingles H
PMID: 8004521 [PubMed - indexed for MEDLINE]
384: Cah O M. 1994 Apr-Jun;47(186):225-44.
[The impact of population growth on Tamba Kosi, a Himalayan valley in Nepal]
[Article in French]
Verliat S.
PIP: Two several-month-long stays in the isolated Tamba Kosi valley in Nepal in
1983 and 1986 allowed an assessment of the importance of changes in rural
societies. In about 50 years, the oldest inhabitants of some villages have seen
the number of houses quadruple. In the absence of reliable statistical data, the
inhabitants say that the Tamba Kosi valley population has doubled in the last 25
years. This population growth exacerbates the multiethnic fight for good land
(i.e., ground of modest slope, hot, and humid). Many people have emigrated, which
has somewhat eased problems relative to population growth. Soil degradation,
which is becoming more and more acute, drives the inhabitants to cut down trees
and clear the land for cultivation of new plots. These new plots are running up
against steep slopes and high altitude. Most families have barely two hectares,
which must suffice to feed 5-6 people on average. This fuels intensification of
agricultural production, resulting in low efficacy. Livestock mutilate forests
with their hooves and teeth. The marked increase in the variety of livestock
accelerates this destruction. Three types of building materials are used in this
high valley: thatch, shingles (fir tree), and bamboo matting. The disappearance
of wild grasses used to make thatch roofs and people moving to higher and higher
altitudes resulted in use of shingles to make roofs. Buildings made of shingles,
which demanded changes in construction techniques, changed the conception of
homes. They became the preferred building type, which increased the demand for
fir trees and deforestation. This lead to a demand for roofing material made of
bamboo matting and another change in construction techniques. The retreat of the
forest and disappearance of the most wanted plant species are the most
spectacular impacts of population growth. This environmental degradation
exacerbates erosion at all bioclimatic altitudes.
Publication Types:
English Abstract
PMID: 12319796 [PubMed - indexed for MEDLINE]
385: P N G Med J. 1994 Mar;37(1):29-39.
Surgery, surgical pathology and HIV infection: lessons learned in Zambia.
Watters DA.
Department of Clinical Sciences, University of Papua New Guinea, Boroko, NCD.
HIV (human immunodeficiency virus) infection is prevalent in many areas of
sub-Saharan Africa. Seropositivity rates reach 10-15% in urban adults, 21% in
critically ill adults and 30% in surgical inpatients aged 21-40 years. AIDS
(acquired immune deficiency syndrome) is a multisystem disease which presents to
the surgeon with a wide range of pathologies including Kaposi's sarcoma,
lymphadenopathy and sepsis. The more common sites for sepsis are the female
genital tract, anorectum, pleural cavity, soft tissues (necrotizing fasciitis)
and bone and joints. To prevent iatrogenic HIV infection more use should be made
of autologous blood. Occupational exposure to HIV infection can be minimized by
double-gloving, protecting the eyes when operating and ensuring that theatre
gowns are waterproof. The risk of HIV infection from a needlestick injury is
0.4%. Although contact with blood during a surgical procedure is common, the risk
is lower than for a hollow needlestick injury.
PIP: In Zambia, 10-15% of urban adults are reported HIV positive, as are over 80%
of prostitutes. The HIV seroprevalence rate in a Lusaka hospital's intensive care
unit was 21% (27% for surgical and 18% for trauma admissions). HIV-infected
patients could be clinically recognized by risk factors or symptoms and signs:
weight loss, chronic cough, chronic diarrhea, sepsis, septic arthritis, subacute
hematogenous osteomyelitis, a history of sexually transmitted diseases (STDs),
death of a spouse or of a child under age 2, recent pregnancy unable to go to
term, poor quality or thin hair, appearance of aging beyond years, mental
slowness, persistent or unexplained fever, lymphadenopathy, aggressive atypical
Kaposi's sarcoma, oral thrush, hairy leukoplakia of the tongue, shingles scars,
and scars of maculopapular dermatitis. Common sites for HIV-related sepsis are
the female genital tract, anorectum, pleural cavity, soft tissues (e.g.,
necrotizing fascitis), and bone and joints. Autologous blood transfusion and use
of donor blood screened for HIV antibodies, preferably limited to emergencies,
would reduce the likelihood of iatrogenic HIV transmission. Surgeons should wear
two pairs of gloves, a waterproof gown, and goggles to protect themselves from
HIV transmission. If they have skin rashes, cuts, or abrasions on the hands or
arms, they should not perform operations. Proper cleaning and disinfection of
endoscopes are required. The risk of infection from a needle stick is small (
0.4%).
Publication Types:
Case Reports
PMID: 7863725 [PubMed - indexed for MEDLINE]
386: Transplantation. 1994 Feb 27;57(4):506-12.
Viral prophylaxis in combined pancreas-kidney transplant recipients.
Stratta RJ, Taylor RJ, Bynon JS, Lowell JA, Cattral MS, Frisbie K, Miller S,
Radio SJ, Brennan DC.
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
The purpose of this study was to analyze different regimens of viral prophylaxis
after combined pancreas-kidney transplantation (PKT). Over a 4-year period, we
performed 82 PKTs with quadruple immunosuppression with OKT3 induction. Four
regimens of prophylaxis were studied. The first 30 patients received standard
intravenous immunoglobulin (IVIG; 0.5 g/kg) for 6 doses and oral acyclovir for 3
months. The next 34 recipients received intravenous ganciclovir (2.5 mg/kg) twice
daily for 2 weeks followed by oral acyclovir for 3 months. In the third group,
patients were randomized to 5 doses over 2 months of either standard IVIG (n = 9)
or CMV hyperimmune globulin (Cytogam; n = 9; 100-150 mg/kg) plus 2 weeks of i.v.
ganciclovir followed by 3 months of oral acyclovir. The 4 groups were similar
with respect to clinical, demographic, and immunologic variables, including donor
and recipient CMV serologic status and blood transfusions. All patients were
monitored for viral infections in the first 6 months after PKT. The regimens of
prophylaxis resulted in (1) no major non-CMV (including no EBV) viral infections;
(2) 3 cases of minor non-CMV viral infections (shingles); and (3) no differences
in the incidence, timing, or severity of symptomatic CMV infections in the 4
groups. No death or graft loss was due to viral infection. Prophylaxis is
effective in reducing the incidence of non-CMV viral infections and may reduce
the severity of symptomatic CMV infection. However, we could not show any added
benefit of either Cytogam or standard IVIG when used in combination with other
antiviral agents. For economic as well as efficacy reasons, we recommended that
IVIG preparations not be used routinely with antilymphocyte therapy but only in
high-risk situations such as primary CMV exposure.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 8116033 [PubMed - indexed for MEDLINE]
387: Infect Control Hosp Epidemiol. 1994 Jan;15(1):61-2.
Valaciclovir more effective than acyclovir in reducing pain from shingles.
[No authors listed]
Publication Types:
News
PMID: 8133011 [PubMed - indexed for MEDLINE]
388: 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)
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 7882700 [PubMed - indexed for MEDLINE]
389: 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.
Publication Types:
Review
PMID: 7514385 [PubMed - indexed for MEDLINE]
390: Drugs. 1994 Jan;47(1):153-205.
Aciclovir. A reappraisal of its antiviral activity, pharmacokinetic properties
and therapeutic efficacy.
Wagstaff AJ, Faulds D, Goa KL.
Adis International Limited, Auckland, New Zealand.
Aciclovir (acyclovir) is a nucleoside analogue with antiviral activity in vitro
against the herpes simplex viruses (HSV), varicella zoster virus (VZV),
Epstein-Barr virus (EBV), cytomegalovirus (CMV) and human herpesvirus 6 (HHV-6).
Topical, oral or intravenous aciclovir is well established in the treatment of
ophthalmic, mucocutaneous and other HSV infections, with intravenous aciclovir
the accepted treatment of choice in herpes simplex encephalitis. The efficacy of
aciclovir is increased with early (preferably during the prodromal period)
initiation of treatment but, despite significant clinical benefit, viral latency
is not eradicated, and pretreatment frequencies of recurrence usually continue
after episodic acute treatment is completed. Intravenous administration has also
shown benefit in the treatment of severe complications of HSV infection in
pregnancy, and neonatal HSV infections. Recurrence of HSV has been completely
prevented or significantly reduced during suppressive therapy with oral aciclovir
in immunocompetent patients. Use of oral aciclovir is effective but controversial
in the treatment of otherwise healthy individuals with varicella (chickenpox),
and in some countries it has been recommended for use only in cases which may be
potentially severe. The development of rash and pain associated with herpes
zoster (shingles) is attenuated with oral or intravenous aciclovir therapy,
ocular involvement is prevented, and post-herpetic neuralgia appears to be
decreased. Similarly, in a few patients with zoster ophthalmicus, oral aciclovir
has reduced the frequency and severity of long term ocular complications and
post-herpetic neuralgia, and herpes zoster oticus is improved with intravenous
aciclovir. Oral aciclovir has prevented recurrence of HSV genital or orofacial
infections during suppressive therapy in > 70% of immunocompetent patients in
most clinical trials. Suppression of latent HSV, VZV and CMV infections has been
achieved in many immunocompromised patients receiving the oral or intravenous
formulations. Aciclovir also appears to offer partial protection from invasive
CMV disease in CMV-seropositive bone marrow transplant recipients. The few
comparative trials published have shown aciclovir to be at least as effective as
other investigated antivirals in the treatment of HSV infections in
immunocompetent patients, and more effective than inosine pranobex in the
prophylaxis of genital herpes. Similarly, in isolated clinical trials, oral
aciclovir appears as effective as topical idoxuridine and oral brivudine in some
parameters in immunocompetent patients with VZV infections, and the intravenous
formulation appears at least as effective as oral brivudine and intravenous
vidarabine in treating these infections in immunocompromised patients.(ABSTRACT
TRUNCATED AT 400 WORDS)
Publication Types:
Review
PMID: 7510619 [PubMed - indexed for MEDLINE]
391: Elder Care. 1993 Nov-Dec;5(6):33.
Surviving shingles.
Hutt A.
Publication Types:
Case Reports
PMID: 8298601 [PubMed - indexed for MEDLINE]
392: 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]
393: Elder Care. 1993 Sep-Oct;5(5):41-4; quiz 45-6.
Herpes zoster (shingles).
Garrett G.
PMID: 8401445 [PubMed - indexed for MEDLINE]
394: JAMA. 1993 Apr 14;269(14):1836-9.
Comment in:
JAMA. 1993 Aug 11;270(6):710.
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.
Publication Types:
Case Reports
Clinical Conference
PMID: 8459517 [PubMed - indexed for MEDLINE]
395: 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.
PMID: 8099271 [PubMed - indexed for MEDLINE]
396: AIDS Action. 1993 Mar-May;(20):6-8.
Diagnosing symptomatic HIV infection and AIDS in adults.
[No authors listed]
PIP: The US Centers for Disease Control in 1982 listed conditions and infections
then associated with AIDS. That case definition, used as a model for many
countries, was designed primarily for epidemiologic surveillance and now includes
more than 20 conditions. The definition, however, requires diagnostic and
laboratory technologies which are not always available in developing countries.
The World Health Organization (WHO) therefore published the Bangui definition in
1985 which uses clinical criteria alone. Many developing countries have adapted
this definition to the types of pathogens they encounter domestically. According
to the AIDS clinical definition, the presence of generalized Kaposi sarcoma or
cryptococcal meningitis is sufficient for the diagnosis of AIDS. AIDS is also
diagnosed if at least two major signs and one minor sign are present in the
absence of known causes of immunosuppression such as malnutrition. Major signs
are fever for more than one month, loss of more than 10% of body weight, and
diarrhea for more than one month. Minor signs include cough for more than one
month, generalized pruritic dermatitis, recurrent herpes zoster or shingles,
oropharyngeal candidiasis or thrush, chronic or aggressive ulcerative herpes
simplex, and persistent generalized lymphadenopathy. WHO has also developed
criteria for diagnosing symptomatic HIV infection as an aid to individual case
management. These criteria, however, are not intended to replace the Bangui AIDS
case definitions developed for epidemiological purposes. The diagnosis of
symptomatic HIV infection is made through physical examination and the taking of
a very detailed case history. In so doing, there may be cardinal, characteristic,
and/or associated findings. Cardinal findings of HIV infection are Kaposi
sarcoma, oesophageal candidiasis, cytomegalovirus retinitis, Pneumocystis carinii
pneumonia, and Toxoplasma encephalitis. Characteristic findings include oral
thrush in a patient not taking antibiotics; hairy leukoplakia; cryptococcal
meningitis; miliary, extrapulmonary,, or non-cavity pulmonary tuberculosis;
current or past herpes zoster or shingles; severe prurigo; Kaposi sarcoma of a
less than generalized or rapidly progressive nature; and high-grade B-cell
extranodal lymphoma. Finally, associated findings in the absence of any other
obvious cause of immunosuppression are recent and/or explained weight loss of
more than 10% of body weight; fever for more than one month; diarrhea for more
than one month; ulcers for more than one month; cough for more than one month;
neurological complaints or findings, peripheral neuropathy, dementia, and
progressively worsening headache; generalized lymphadenopathy; previously unseen
drug reactions; and severe or recurrent skin infections. A person has symptomatic
HIV infection if there are one or more cardinal findings, two or more
characteristics findings, one characteristic finding and two or more associated
findings, three or more associated findings together with any risk factors, or
two associated findings together with a positive HIV test result. Malawi, Zambia,
Thailand, and the English-speaking Caribbean are adapting these criteria for
national use.
PMID: 12288934 [PubMed - indexed for MEDLINE]
397: 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.
Publication Types:
English Abstract
PMID: 9702246 [PubMed - indexed for MEDLINE]
398: J Med Virol. 1993;Suppl 1:90-2.
Treatment of varicella in the immunocompetent adult.
Wallace MR, Bowler WA, Oldfield EC 3rd.
Department of Internal Medicine (Infectious Disease Division), Naval Hospital,
San Diego, California 92134-5000.
Varicella in the immunocompetent adult is an infrequent but potentially serious
infection. Previous studies in immunocompetent hosts and normal adults have
demonstrated the value of intravenous acyclovir in the treatment of
varicella-zoster virus infections. Oral acyclovir has also shown efficacy in both
normal adults with zoster (shingles) and immunocompetent children with varicella.
A recently completed double-blind placebo-controlled study of oral acyclovir in
immunocompetent adults with uncomplicated varicella also demonstrated efficacy.
Therapy within the first day reduced the time to 100% crusting of skin lesions
from 7.4 to 5.6 days, and reduced the duration of fever by one-half day. Symptoms
were also diminished. These benefits were observed only when therapy was
initiated within 24 hours of the appearance of the rash. Adults with complicated
varicella (usually symptomatic varicella pneumonia) should receive intravenous
acyclovir. Several new agents for varicella-zoster therapy are being evaluated;
brovavir is a new agent currently being compared to placebo in the treatment of
adult varicella.
Publication Types:
Review
PMID: 8245900 [PubMed - indexed for MEDLINE]
399: 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)
Publication Types:
Clinical Trial
PMID: 8245873 [PubMed - indexed for MEDLINE]
400: 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.
Publication Types:
Review
PMID: 1330279 [PubMed - indexed for MEDLINE]
401: J Infect Dis. 1992 Nov;166(5):1157-9.
Detection of varicella-zoster virus DNA in human geniculate ganglia by polymerase
chain reaction.
Furuta Y, Takasu T, Fukuda S, Sato-Matsumura KC, Inuyama Y, Hondo R, Nagashima K.
Department of Pathology, Hokkadio University, School of Medicine, Sapporo, Japan.
Latent varicella-zoster virus (VZV) has been demonstrated in the human trigeminal
and thoracic ganglia by means of nucleic acid hybridization. However, the human
geniculate ganglia in VZV latency have not been examined. Tissue DNA extracted
from the trigeminal and geniculate ganglia of a newborn and 7 adults was examined
by polymerase chain reaction with a pair of VZV-specific primers. None had
symptoms of recent infection with VZV (chickenpox or shingles). VZV DNA was
detected in 11 (79%) of 14 trigeminal ganglia and in 9 (69%) of 13 geniculate
ganglia of the adults. VZV DNA was not detected in either type of ganglion from
the newborn or from 1 adult who was seronegative for VZV antibodies. These
findings indicate that VZV becomes latent in human geniculate ganglia after
primary infection and suggest the possibility that reactivation of the virus from
the geniculate ganglia may cause Ramsay Hunt syndrome.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 1328403 [PubMed - indexed for MEDLINE]
402: Cancer Epidemiol Biomarkers Prev. 1992 Nov-Dec;1(7):533-6.
Medical history and the risk of non-Hodgkin's lymphomas.
La Vecchia C, Negri E, Franceschi S.
Istituto di Ricerche Farmacologiche, Mario Negri, Milan, Italy.
The relationship between selected aspects of medical history and the risk of
non-Hodgkin's lymphomas (NHLs) was investigated using data from a hospital-based
case-control study conducted in northern Italy on 177 cases of NHL and 561
controls in hospital for acute conditions, other than nonneoplastic or
immunological. Among six viral diseases considered, only herpes zoster (shingles)
had a relative risk (RR) significantly above unity [RR = 2.7; 95% confidence
intervals (CI), 1.5 to 4.7]. The association, however, was restricted to subjects
whose diagnosis of herpes zoster dated back to less than 10 years, suggesting
that this slow-acting virus could be reactivated by the early development of NHL.
Six of eight bacterial diseases considered showed RR above unity, and the
estimate was significant for scarlet fever (RR = 1.9; 95% CI, 1.1 to 3.5) and
pyelonephritis (RR = 5.3; 95% CI, 1.8 to 16.2). These associations were not
restricted to the few years before lymphoma diagnosis. When various classes of
infectious or inflammatory diseases were grouped together, no association was
evident for viral infections (RR = 0.8; 95% CI, 0.6 to 1.2), acute bacterial
diseases (RR = 1.0; 95% CI, 0.7 to 1.5), or allergic conditions (RR = 1.0; 95%
CI, 0.6 to 2.1). The risk estimates were nonsignificantly above unity for chronic
bacterial diseases (RR = 1.2; 95% CI, 0.7 to 1.2) and autoimmune conditions (RR =
1.4; 95% CI, 0.9 to 2.2), and significantly elevated for chronic inflammatory
disease (RR = 1.9; 95% CI, 1.2 to 3.0).(ABSTRACT TRUNCATED AT 250 WORDS)
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 1302565 [PubMed - indexed for MEDLINE]
403: Pediatr Nurs. 1992 Sep-Oct;18(5):499-503.
Acyclovir in the treatment of chickenpox.
Farrington E.
Although chickenpox is a highly contagious disease affecting 90% of susceptible
persons exposed, its morbidity and mortality in healthy patients is minimal.
Treatment of chickenpox with oral acyclovir appears to decrease the number of pox
lesions and shorten the duration of new lesion formation. Most importantly,
children treated with acyclovir begin to feel better soon and had fewer systemic
signs and symptoms of chickenpox (fever, fatigue, loss of appetite). However, the
greatest mortality from chickenpox is seen in the immunocompromised patient, or
in elderly patients with zoster (shingles) due to reactivation of latent
varicella infection. Therefore, prevention of varicella is necessary to decrease
mortality from the varicella-zoster virus. It is hopeful that the varicella
vaccine will be licensed in the U.S. for routine immunization of healthy children
within the next year. While its general use will not eliminate either chickenpox
or zoster, there will be a considerable decrease in the morbidity and mortality
caused by this agent as a result of routine immunization.
PMID: 1408423 [PubMed - indexed for MEDLINE]
404: 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.
Publication Types:
Review
PMID: 1390036 [PubMed - indexed for MEDLINE]
405: J Virol. 1992 Sep;66(9):5298-304.
Erratum in:
J Virol 1995 Apr;69(4):2723.
Regulation of varicella-zoster virus gene expression in human T lymphocytes.
Perera LP, Mosca JD, Ruyechan WT, Hay J.
Department of Microbiology, Uniformed Services University of the Health Sciences,
Bethesda, Maryland 20814-4799.
Varicella-zoster virus (VZV), a neurotropic alphaherpesvirus, is the etiologic
agent of chicken pox and shingles (zoster) in humans. Using an in vitro transient
expression assay, we have evaluated the ability of the putative immediate early
VZV genes, ORF4, ORF61, and ORF62 (the analogs of the herpes simplex virus alpha
27, alpha 0, and alpha 4 genes, respectively), to modulate the expression of VZV
genes of different putative kinetic classes in a human T lymphocyte cell line.
These cells are of the type in which VZV can be readily detected in the viremic
phase of human infection. We present evidence to indicate that, in this system,
the gene product of ORF62 (IE62) is a major regulatory protein in VZV and is
capable of activating VZV genes of all putative kinetic classes. In addition, we
demonstrate that the gene product of ORF4 and, unlike the apparent situation in
Vero cells, the gene product of ORF61 may play an accessory regulatory role in
synergizing the activation of VZV genes induced by the gene product of ORF62 in
human T lymphocytes.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 1323696 [PubMed - indexed for MEDLINE]
406: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 1378081 [PubMed - indexed for MEDLINE]
407: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Review
PMID: 1320648 [PubMed - indexed for MEDLINE]
408: 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.
Publication Types:
Case Reports
PMID: 1320320 [PubMed - indexed for MEDLINE]
409: 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.
Publication Types:
Review
PMID: 1538264 [PubMed - indexed for MEDLINE]
410: 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.
Publication Types:
Case Reports
Research Support, U.S. Gov't, Non-P.H.S.
PMID: 1802963 [PubMed - indexed for MEDLINE]
411: J R Soc Med. 1991 Mar;84(3):184.
Comment on:
J R Soc Med. 1990 Oct;83(10):617-9.
Epidemiology of shingles.
[No authors listed]
Publication Types:
Comment
Letter
PMID: 2013914 [PubMed - indexed for MEDLINE]
412: Hautarzt. 1991 Feb;42(2):72-6.
[Results of virostatic treatment of varicella with various severity]
[Article in German]
Stary A.
Ludwig Boltzmann-Institut zur Erforschung infektiöser venero-dermatologischer
Erkrankungen, Wien.
Chickenpox is the result of primary infection with the varicella zoster virus
(VZV), which--like other herpes-viruses--has the ability to remain latent within
the nervous system; reactivation then sometimes causes shingles many decades
later. While chickenpox is benign in normal children, infection in the
immunocompromised patient is characterized by a period of prolonged viral
replication, delayed healing and a high frequency of extracutaneous
manifestations, such as pneumonitis and involvement of the nervous system.
Therefore, current therapeutic research efforts have focused on both the
prevention of VZV infections through the development of a live, attenuated
vaccine and improved therapeutic modalities. The existing antiviral drug
acyclovir has been shown to be effective in reducing severe complications in risk
groups. It has been generally accepted that the varicella vaccine is useful in
immunocompromised children with acute leukaemia or solid malignant tumours.
Healthy seronegative siblings will also benefit from the varicella vaccine. In
addition, zoster hyperimmunoglobulin has also been shown to provide protection
against primary VCV infection in the incubation period. Preventive and
therapeutic efforts should mean that varicella will soon no larger be a medical
problem even for immunocompromised patients.
Publication Types:
English Abstract
Review
PMID: 1645331 [PubMed - indexed for MEDLINE]
413: Fundam Appl Toxicol. 1991 Jan;16(1):61-70.
Acute testicular toxicity of 1,3-dinitrobenzene and ethylene glycol monomethyl
ether in the rat: evaluation of biochemical effect markers and hormonal
responses.
Reader SC, Shingles C, Stonard MD.
ICI plc., Central Toxicology Laboratory, Cheshire, United Kingdom.
The studies described in this paper were undertaken to evaluate the use of plasma
enzymes of testicular origin and plasma hormones as markers of acute testicular
toxicity. Rats were dosed by gavage with a single dose of either
1,3-dinitrobenzene (1,3-DNB) or ethylene glycol monomethyl ether (EGME). Two
experimental designs were used: a dose response and a time-dose response course.
Lactate dehydrogenase isozyme C4 (LDH-C4) and sorbitol dehydrogenase (SDH) were
used as germ cell markers and leucine aminotransferase (LAT) and androgen binding
protein (ABP) were used as Sertoli cell markers. Luteinizing hormone (LH),
follicle-stimulating hormone (FSH), and testosterone were also monitored.
Histopathology confirmed the known testicular toxicity of 1,3-DNB and EGME.
1,3-DNB induced Sertoli cell damage with associated degenerative changes in late
pachytene spermatocytes. The effects of EGME were mainly on early and late
pachytene and dividing spermatocytes. No changes in either testicular or plasma
SDH or LAT were found. Similarly no effects were observed for plasma LH or
testosterone. However testicular LDH-C4 and testosterone, plasma LDH-C4, ABP, and
FSH did show compound related effects. LDH-C4 was reduced in testis and increased
in plasma with both compounds and plasma LDH-C4 remained elevated up to 14 days
after dosing. ABP levels in plasma were increased with 1,3-DNB and EGME. A
reduction in testicular testosterone levels was recorded and plasma FSH
concentrations were elevated after EGME treatment. It is concluded that plasma
LDH-C4 activity and ABP may be of diagnostic value in acute testicular toxicity.
Increases in plasma LDH-C4 precede noticeable histological findings.
PMID: 1902188 [PubMed - indexed for MEDLINE]
414: J R Soc Med. 1990 Oct;83(10):617-9.
Comment in:
J R Soc Med. 1991 Mar;84(3):184.
Epidemiology of shingles.
Glynn C, Crockford G, Gavaghan D, Cardno P, Price D, Miller J.
Oxford Regional Pain Relief Unit, Abingdon Hospital, Leeds.
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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 1962821 [PubMed - indexed for MEDLINE]
415: N Engl J Med. 1990 Sep 6;323(10):627-31.
Latent varicella-zoster viral DNA in human trigeminal and thoracic ganglia.
Mahalingam R, Wellish M, Wolf W, Dueland AN, Cohrs R, Vafai A, Gilden D.
Department of Neurology, University of Colorado Health Sciences Center, Denver
80262.
BACKGROUND. Some human herpesviruses become latent in dorsal-root ganglia.
Primary infection with the varicella-zoster virus causes chickenpox, followed by
latency, and subsequent reactivation leading to shingles (zoster), but the
frequency and distribution of latent virus have not been established. METHODS.
Using the polymerase chain reaction, we performed postmortem examinations of
trigeminal and thoracic ganglia of 23 subjects 33 to 88 years old who had not
recently had chickenpox or shingles to identify the presence of latent
varicella-zoster viral DNA. Oligonucleotide primers representing the origin of
replication of the varicella-zoster virus and varicella-zoster virus gene 29 were
used for amplification. RESULTS. Among the 22 subjects seropositive for the
antibody to the virus, both the viral origin-of-replication and gene-29 sequences
were detected in 13 of 15 subjects (87 percent) in whom trigeminal ganglia were
examined and in 9 of 17 (53 percent) in whom thoracic ganglia were examined.
Viral DNA was not detected in brain or mononuclear cells from the seropositive
subjects. None of three thoracic ganglia from the one seronegative subject
contained varicella-zoster viral DNA. CONCLUSIONS. These findings indicate that
after primary infection with varicella-zoster virus (varicella), the virus
becomes latent in many ganglia--more often in the trigeminal ganglia than in any
thoracic ganglion--and that more than one region of the viral genome is present
during latency.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 2166914 [PubMed - indexed for MEDLINE]
416: Br J Clin Pract Suppl. 1990 Sep;71:109-13.
Skin manifestations in AIDS patients.
Staughton R.
Department of Dermatology, Westminster Hospital, London, UK.
Skin lesions occur in virtually all patients during the unfolding evolution of
their HIV infection--usually a succession of conditions reflecting the gradual
decline of immunity. Hairy leucoplakia can occur at any stage and in all risk
groups. Kaposi's sarcoma is seen only in homosexually acquired AIDS. A transient
rash may accompany the initial HIV seroconversion illness, but may go unnoticed.
Documented examples show macular red oval lesions, similar to pityriasis rosea,
but extending onto the face, palms and soles, preceded by a flu-like illness with
lymphadenopathy and lymphopenia simulating glandular fever. Seroconversion occurs
within weeks. During the following weeks or years the gradually declining
immunity may only be documented by decreasing numbers of CD4 positive lymphocytes
with the emergence of 'idiopathic' inflammatory skin conditions (eg, seborrhoeic
dermatitis, psoriasis), as well as autoimmune conditions (eg, thrombocytopenia,
morphoea or alopecia areata). As immunity itself declines, skin infections
emerge. Shingles affects over 25% of HIV-positive patients--sometimes involving
numerous dermatomes, accompanied by multiple distant chicken pox lesions and
followed by post-herpetic neuralgia. Onychomycosis and tinea pedis are universal,
but sometimes occult patterns with follicular lesions due to Trichophyton rubrum
may spread widely over the beard and chest. Uncomfortable mucosal candidosis,
sometimes with oesophageal extension, may only become controllable with oral
imidazoles. Molluscum contagiosum may be seen in hundreds over large areas, whole
soles can be shod in verrucae and vulgar warts appear in the most unusual sites,
for example on the palate or up nostrils. Dry skin develops into acquired
ichthyosis and eczema crackelГ©.(ABSTRACT TRUNCATED AT 250 WORDS)
Publication Types:
Review
PMID: 2091731 [PubMed - indexed for MEDLINE]
417: AIDS Action. 1990 Apr;(10):2-3.
Skin conditions common to people with HIV infection or AIDS.
Kalibala S.
PIP: The World Health Organization clinical criteria for AIDS diagnosis in Africa
include Kaposi's sarcoma, Herpes zoster, Herpes simplex, and pruritic
maculopapular rash, which have a predictive value for HIV seropositivity of
71-98%. Skin conditions may be classified as: 1) generalized dermatitis, 2)
bacterial, fungal, viral, and parasitic infections, and 3) skin tumors. Pruritic
maculopapular rash (prurigo) is often the first outward sign of HIV infection.
Soothing preparations such as calamine lotion or E45 emollient cream can be
applied. Occasionally antihistamine may be necessary, e.g., 10 mg of
chlorpheniramine 8 hourly. Skin lesions may become secondarily infected with
bacteria; usually Staphylococcus aureus and Streptococcus species. Persistent
folliculitis or carbuncles should be treated with flucloxacillin 250 mg QDS for 7
days. In HIV/AIDS fungal infections often develop secondary infection.
Candidiasis (thrush) is caused by yeasts, mainly Candida albicans and a small
percentage by Tolurosis glabrata. Many HIV-infected patients suffer from
seborrheic dermatitis. Fungal diseases more typically present as ringworms of the
scalp (Tinea capitis). Whitfield's ointment is effective for ringworm. Antifungal
creams such as miconazol or clotrimazole and systemic antifungal tablets such as
ketoconazole, fluconazole, and itraconazole are also effective. Gentian violet
lotion twice daily and Acyclovir tablets, 200 mg 5 times daily for 5 days, may
help to reduce secondary Herpes simplex infection. HIV has been associated with
an increased incidence of Herpes zoster (shingles). It is often necessary to give
analgesics like aspirin or paracetamol to control the pain. Gentian violet paint
may help to prevent secondary infection. When shingles affects the eye, Acyclovir
tablets (800 mg 5 times daily) should be given. Kaposi's sarcoma affects wider
age groups, and it is disseminated and more aggressive than the endemic type.
Treatment options include radiotherapy and systemic cytotoxics such as
vincristine. Intralesional injections of the drug interferon have also given
successful results with some patients.
PMID: 12342834 [PubMed - indexed for MEDLINE]
418: 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.
Publication Types:
Case Reports
PMID: 2349753 [PubMed - indexed for MEDLINE]
419: Minn Med. 1990 Apr;73(4):37-40.
Comment in:
Minn Med. 1990 Dec;73(12):11-2. Minn Med. 1990 Nov;73(11):7-8.
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.
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.
Publication Types:
Case Reports
Review
PMID: 2186265 [PubMed - indexed for MEDLINE]
420: Acta Stomatol Belg. 1990 Mar;87(1):15-56.
[Clinical approach to herpesviruses. A composite overview]
[Article in French]
Piette E.
Department of Oral Surgery and Oral Medicine, Prince Philip Dental Hospital,
University of Hong Kong.
This review article describes the lesions due to herpesviruses: herpes simplex,
chickenpox, herpes zoster (shingles), and infections due to cytomegalovirus and
Epstein-Barr virus. Based on current literature, clinical signs, diagnostic
methods and therapeutic possibilities are given for each type of infection. B
virus infections of humans are also briefly described.
Publication Types:
English Abstract
Review
PMID: 2164319 [PubMed - indexed for MEDLINE]
421: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 2313300 [PubMed - indexed for MEDLINE]
422: 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.
Publication Types:
Case Reports
Review
PMID: 2695590 [PubMed - indexed for MEDLINE]
423: 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]
424: Med J Aust. 1989 Sep 18;151(6):360.
Treatment of prodromal shingles.
Petersons VV.
Publication Types:
Letter
PMID: 2593954 [PubMed - indexed for MEDLINE]
425: BMJ. 1989 Sep 16;299(6701):740-1.
Treatment of shingles and post-herpetic neuralgia.
[No authors listed]
Publication Types:
Letter
PMID: 2508905 [PubMed - indexed for MEDLINE]
426: BMJ. 1989 Aug 5;299(6695):392-3.
Comment on:
BMJ. 1989 Jun 10;298(6687):1537-8.
Treatment of shingles and post-herpetic neuralgia.
[No authors listed]
Publication Types:
Comment
Letter
PMID: 2506989 [PubMed - indexed for MEDLINE]
427: BMJ. 1989 Jul 1;299(6690):55.
Comment on:
BMJ. 1989 Jun 10;298(6687):1537-8.
Treatment of shingles and post-herpetic neuralgia.
Schieff C.
Publication Types:
Comment
Letter
PMID: 2503218 [PubMed - indexed for MEDLINE]
428: Med J Aust. 1989 Jun 19;150(12):727.
Treatment of prodromal shingles.
Bateman PP.
Publication Types:
Case Reports
Letter
PMID: 2733628 [PubMed - indexed for MEDLINE]
429: BMJ. 1989 Jun 10;298(6687):1537-8.
Comment in:
BMJ. 1989 Aug 26;299(6698):568. BMJ. 1989 Aug 5;299(6695):392-3. BMJ. 1989 Jul 1;299(6690):55.
Treatment of shingles and post-herpetic neuralgia.
Jolleys JV.
Publication Types:
Review
PMID: 2503110 [PubMed - indexed for MEDLINE]
430: Zentralbl Hyg Umweltmed. 1989 May;188(1-2):127-43.
[Fiber emissions from weathered asbestos cement products. 1. Fiber release in
ambient air]
[Article in German]
Spurny K, Marfels H, Boose C, Weiss G, Opiela H, Wulbeck FJ.
Fraunhofer-Institut fГјr Umweltchemie und Okotoxikologie in
Schmallenberg-Grafschaft.
Emissions of fibrous aerosols were measured on buildings with weathered and
corroded asbestos-cement-plates (roofing and facade shingles) by means of an
already published equipment and procedure. The measured emission factors for
asbestos fibers longer than 5 microns were in the range of 10(6) to 10(8)
fibers/m2.h. They depended on the type of the AC-plates as well as on their age
and corrosion intensity.
Publication Types:
English Abstract
Research Support, Non-U.S. Gov't
PMID: 2757737 [PubMed - indexed for MEDLINE]
431: Ugeskr Laeger. 1989 Apr 10;151(15):935-7.
[A mini epidemic of varicella zoster virus reinfection at a department of
hematology]
[Article in Danish]
Junker K, Avnstorp C, Nielsen CM, Hansen NE.
Whereas primary infection with varicella zoster virus (VZV) (chickenpox) and
reactivation of VZV (shingles) are common and recognized, clinical reinfection
with VZV is rare. A little epidemic of presumed reinfection with VZV in six
immune-compromised adults is presented here. The epidemic lasted for three
months, during which a healthy young woman also developed a primary VZV infection
in the form of chickenpox. In the immune-compromised patients, the clinical
picture was dominated by disseminated, prolonged and frequently haemorrhagic and
necrotic eruptions which may cause diagnostic difficulties. Skin biopsy proved
helpful in the diagnosis while demonstration of the VZV antigen in the skin
elements was specific and sensitive. All of the patients, with one exception,
were treated with acyclovir and dissemination of the infection to the inner
organs did not occur. One patient may have died on account of the VZV infection.
In conclusion, immune-incompetent patients must be warned against infection from
chickenpox or disseminated herpes zoster. In cases of proved exposure,
prophylactic treatment with acyclovir should be considered and, in cases of
clinical disease, immediate treatment with 10 mg acyclovir per kg body weight
should be administered intravenously thrice daily.
Publication Types:
Case Reports
English Abstract
PMID: 2540583 [PubMed - indexed for MEDLINE]
432: 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]
433: 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.
Publication Types:
Case Reports
PMID: 2707055 [PubMed - indexed for MEDLINE]
434: Med J Aust. 1989 Feb 20;150(4):227-8.
Treatment of prodromal shingles.
Kowal L.
Publication Types:
Case Reports
Letter
PMID: 2785634 [PubMed - indexed for MEDLINE]
435: Med Trop (Mars). 1989 Jan-Mar;49(1):21-8.
[Infection by the human immunodeficiency virus (HIV) in French Guyana.
Dermato-venereologic problems]
[Article in French]
Pradinaud R, Sainte-Marie D, Girardeau I, Cassiede P.
Service de Dermato-Vénéréologie, Centre Hospitalier de Cayenne, Guyane Française.
Dermato-venereal manifestations in HIV infection and its severe evolution stage,
AIDS, is of particular importance in tropical zones: We may be suspicious of the
viral infection and consequently to request serologic tests to confirm it. We get
an explanation of the virus transmission during heterosexual relations by the
frequent occurrence and importance of the genital manifestations, leading to
consider AIDS as a true sexually transmitted disease. Beside the classical
opportunistic infections, the authors draw the attention to three types of
manifestations: prurigo, already well known in HaГЇti and Africa capillary
dystrophies, already reported in HaГЇti donovanosis that, because its
epidemiological and etiopathological peculiarities, should be listed within the
possible opportunistic infection if we take into consideration the regional
pathological environment. In an other correction, syphilis, lepra and cutaneous
leishmaniasis have to be carefully monitored, because they are capable to
evaluate unexpectedly in some immunodepressive diathesis. Importance of
dermato-venereal pathology in black people in tropical zone is explained by the
weakness of cutaneous corneal stratum, immunologic disorders linked up to
accumulated parasitic pathologies, socio-cultural life with a sexuality without
complex.
PIP: Cutaneous manifestations of AIDS in the 1st 91 cases diagnosed in French
Guiana between 1982-October 1987 included 40 cases of candidiasis, 29 of prurigo,
13 of herpes simplex, 5 of trichomoniasis, 7 of human papilloma virus, 3 of
shingles, 3 of donovanoses, and 1 of Kaposi's sarcoma. There were also 7 cases of
seborrheic dermatitis, 6 of capillary dystrophies, and 1 of leucoplasia. 26 of
the 40 cases of candidiasis were buccal or buccopharyngeal and 14 were vaginal.
Such infections are intense, chronic, and easy to diagnose. Local treatment with
Nystatin or Amphotericin B in solution for buccal cases and with imidazole
derivatives for vaginal cases should be supplemented with systemic medications
such as ketoconazole. Most herpes simplex cases are type 2 genital infections
which may be chronic and extensive. A perfusion of Aciclovir usually gives good
results in 5 or 6 days. Shingles during AIDS often has nonthoracic localizations;
involves itching, pain, and burning sensations; is recurrent, perhaps on the
contralateral side; and may leave scars. Sensitivity to Aciclovir is less than
for herpes simplex. Human papilloma virus lesions that are not too large are
treated locally. Although tuberculosis is in 2nd place after candidiasis among
opportunistic infections in AIDS patients in French Guiana. Only 2 cases of
cutaneous tuberculosis were observed. 3 cases of Donovanosis due to
Calymmatobacterium granulomatis were observed, with 2 cases with 1 couple.
Chronic prurigo has been observed frequently in AIDS patients in Africa and
Haiti. Along with asthenia, polyadenopathies, and shingles, it is often an early
sign of AIDS. The pruritus becomes more and more intense and the only treatment
providing some relief is local corticotherapy. The dermatovenereal signs of AIDS
in tropical environments should raise suspicions of the disease in undiagnosed
cases, and they also provide an explanation for the high rate of heterosexual
transmission in individuals with various disorders involving genital lesions.
Some dermatological disorders common in French Guiana have not been observed in
AIDS patients to date.
Publication Types:
English Abstract
PMID: 2725241 [PubMed - indexed for MEDLINE]
436: AIDS Action. 1988 Dec;(5):5.
Uganda: paediatric AIDS.
Ndugwa CM, Friesen H.
PIP: The occurrence of reported cases of AIDS in children in Uganda, and the most
common symptoms are discussed. By May 1988, 359 cases of AIDS in children has
been reported. All but 12 were in babies less than 2 years of age, suggesting
that maternal transmission, rather than casual contact, had caused the infection.
Information was available on HIV status of 224 mothers. 42% of these had AIDS or
ARC (AIDS related complex). 85 of 87 mothers whose sera had been tested were
positive for HIV. Blood testing is not accurate in children until about 15 months
of age, since maternal antibodies persist after birth. The most common symptoms
seen in childhood AIDS in Uganda are weight loss, failure to thrive, chronic
diarrhea, and repeated, chronic oral thrush (candidiasis). Other indicators are
otitis media, generalized dermatitis, tuberculosis, septicemia and meningitis.
Less common signs are shingles, Kaposi's sarcoma and Cryptospor meningitis. Some
of these clinical findings are common in this area, so it is important to define
a working clinical case definition of pediatric AIDS.
PMID: 12281632 [PubMed - indexed for MEDLINE]
437: Trop Doct. 1988 Oct;18(4):147-50.
Clinical manifestations of AIDS in tropical countries.
Carswell JW.
PIP: Diagnosis of clinical AIDS can be difficult for clinicians in Africa, where
there is only limited access to the sophisticated bacteriological diagnostic
facilities needed for diagnoses based on the criteria laid down by the Center for
Disease Control in the US. The most common presentation of AIDS in Africa is as
an enteropathic condition known as 'Slim.' Based on this and other common
presentations of the disease in Africa, a group of clinicians in Bangui, Central
African Republic, drew up a list of criteria for the diagnosis of AIDS in Africa
which are based on patient history and examination and the exclusion of other
conditions rather than on serological confirmation of HIV infection. The major
criteria are 1) unexplained fever for longer than 1 month; 2) unexplained
diarrhea for longer than 1 month; and 3) weight loss greater than 10% of previous
weight. Minor symptoms are presence of a maculopapular rash, oral candidiasis or
thrush, herpes zoster or shingles, aggressive or uncontrollable herpes simplex,
unexplained cough for longer than 1 month, or enlarged lymph nodes in more than 1
extrainguinal site. The finding of 2 major symptoms and at least 1 minor one is
enough for diagnosis. These criteria have been found to be useful. However, they
do not cover all the presentations which have been associated with AIDS. Unusual
presentations of HIV infected persons which have been seen in Africa include
serially developing abscesses in pyomyositis, gall bladder diseases, pericarditis
or myocarditis, diseases of the Central Nervous System (cryptococcal meningitis,
toxoplasmosis, non-specific leuko-encephalitis, atraumatic paraplegia, acute
psychosis or chronic deterioration in mental capacity, lymphoma of the brain),
prodromal illnesses, swollen lymph nodes, herpes zoster or shingles in young
adults, or tumours of the lymphatic system. Differential diagnosis is extremely
important.
PMID: 3194942 [PubMed - indexed for MEDLINE]
438: N Z Med J. 1988 Jul 13;101(849):461.
A new shingles therapy.
Acland RH.
Publication Types:
Letter
PMID: 3399188 [PubMed - indexed for MEDLINE]
439: 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.
PMID: 3395559 [PubMed - indexed for MEDLINE]
440: 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.
Publication Types:
Case Reports
PMID: 3376780 [PubMed - indexed for MEDLINE]
441: Biosci Rep. 1988 Feb;8(1):85-94.
Methyl gallate, methyl-3,4,5-trihydroxybenzoate, is a potent and highly specific
inhibitor of herpes simplex virus in vitro. I. Purification and characterization
of methyl gallate from Sapium sebiferum.
Kane CJ, Menna JH, Yeh YC.
Department of Biochemistry & Molecular Biology, College of Medicine, University
of Arkansas for Medical Sciences, Little Rock 72205.
A potent anti-herpetic compound was identified and purified to homogeneity from
the leaves of Sapium sebiferum by plaque reduction assay using herpes simplex
virus type 2. The chemical structure of the purified compound was determined by
mass spectroscopy and proton and carbon-13 nuclear magnetic resonance as methyl
gallate, methyl-3,4,5-trihydroxybenzoate. This is the first demonstration that
methyl gallate is a potent anti-herpetic compound in vitro, present in high
concentration in the leaves of S. sebiferum, a Chinese folk medicine for
shingles.
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 2840132 [PubMed - indexed for MEDLINE]
442: Bull Soc Pathol Exot Filiales. 1988;81(2):159-62.
[Acquired immunodeficiency syndrome (AIDS) in Lubumbashi. Clinical and
epidemiological observations]
[Article in French]
Masengo-Bwanga , Bula Bula A, Tambwe Mbuyi M, Maloba Nday , Kalenga B, Luboya N.
Service de mГ©decine interne, Cliniques universitaires de Lubumbashi, ZaГЇre.
26 AIDS cases (13 males and 13 females) have been noticed in the internal
medicine service of the Lubumbashi University Clinics, town at the boundary of
the south-east of ZaГЇre. The clinical data are conventional: only heterosexual
transmission seems prevalent. The shortage of HIV diagnosis means restrain larger
survey, but 5 to 7% of blood givers are AIDS carriers. The risk of AIDS
dissemination is real, even in rural areas of some regions with permanent
connections of larger urban centres.
PIP: Observation of 13 male and 13 female AIDS patients hospitalized in the
internal medicine service at the Lubumbashi University Clinics between June
1985-October 1987 indicates that AIDS is a threat in other large cities of Zaire
besides Kinshasa. Patient ages ranged from 14 to 65 and averaged 35. All 26
experienced profound weight loss, 17 had chronic diarrhea, 10 had fevers, and 10
had pneumathies. 5 had esophageal moniliasis, 2 had dermatoses, 1 had meningeal
cryptococcosis, 1 had Kaposi's sarcoma, 1 had shingles, and 1 had salmonellosis.
ELISA tests were administered in only 16 cases due to their cost. 17 of the
patients were from Lubumbashi.
Publication Types:
English Abstract
PMID: 3416403 [PubMed - indexed for MEDLINE]
443: Br Med J (Clin Res Ed). 1987 Oct 10;295(6603):926-7.
Acyclovir for shingles.
Chase AO.
Publication Types:
Letter
PMID: 3119110 [PubMed - indexed for MEDLINE]
444: J Neurol. 1987 Aug;234(6):437-9.
Guillain-BarrГ© 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-BarrГ© 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-BarrГ© syndrome. An alteration in the balance of helper and suppressor
lymphocytes may be an important pathogenetic mechanism.
Publication Types:
Case Reports
Review
PMID: 3309194 [PubMed - indexed for MEDLINE]
445: Hematol Oncol. 1987 Jul-Sep;5(3):213-22.
VAD chemotherapy--toxicity and efficacy--in patients with multiple myeloma and
other lymphoid malignancies.
Anderson H, Scarffe JH, Lambert M, Smith DB, Chan CC, Chadwick G, McMahon A,
Chang J, Crowther D, Swindell R.
CRC Department of Medical Oncology, Christie Hospital, Manchester, U.K.
Thirty-three patients with multiple myeloma (11 untreated, 15 refractory and
seven relapsed patients) have received vincristine and adriamycin infusion
therapy with oral dexamethasone (VAD). The median number of course received was
five. In addition 16 patients with lymphoid malignancy have received a median of
four courses of VAD. Three patients who relapsed after VAD have received further
VAD therapy making 52 patient treatments assessable for toxicity. Ten per cent
had nausea, 4 per cent vomiting, 4 per cent total alopecia, 25 per cent
constipation, 33 per cent paraesthesiae, 8 per cent proximal myopathy, 33 per
cent dyspepsia, 23 per cent proven bacteraemia, and 19 per cent chest infections.
Infections were not usually associated with neutropenia. Shingles was seen in
four patients with myeloma, but none of the patients with lymphoid malignancy.
The response rate in myeloma was 9/11, for previously untreated patients, 3/7 for
relapsed, and 8/15 for refractory patients. Responses have been seen in other
lymphoid malignancies-1/2 patients with relapsed acute lymphoblastic leukaemia
had a complete remission. Two out of seven patients with chronic lymphocytic
leukaemia achieved a partial remission, and a further three had a clinical
improvement. Three out of six patients with non-Hodgkin lymphoma and one patient
with macroglobulinaemia achieved a partial remission.
PMID: 3115884 [PubMed - indexed for MEDLINE]
446: 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.
Publication Types:
Clinical Trial
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 3334658 [PubMed - indexed for MEDLINE]
447: 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.
Publication Types:
Review
PMID: 3332795 [PubMed - indexed for MEDLINE]
448: Gynecol Endocrinol. 1987 Jun;1(2):177-93.
Trial of 17-hydroxyprogesterone caproate (Proluton Depot) in women with
long-standing infertility; failure of estrogen positive feedback the following
cycle.
Mavroudis K, Petsos P, Zulkifli Z, Cantrill J, Shingles C, Newman M, Mamtora H,
Ratcliffe WA, Anderson DC.
University of Manchester Department of Medicine, (Endocrinology), Hope Hospital,
Salford, UK.
In open and double-blind studies 40 women with long-standing unexplained
infertility were investigated and treated with 17 alpha-hydroxyprogesterone
caproate (17HPC, Proluton Depot). In the open study, 16 women with a high index
of suspicious abortions were given 500 mg 17HPC imtramuscularly (i.m.) weekly for
6-16 weeks. Six of the women received the drug from a time preceding the expected
date of a period; 2 of these conceived that cycle and their pregnancies continued
to term, while 4 were not pregnant. Ten women (9 with definite previous
abortions) were given 17HPC when they suspected (correctly) that they were
pregnant. Their pregnancies continued to term in all but 1, who had a premature
delivery (still-birth) at 34 weeks. In the double-blind study 24 women were given
injections of 17HPC or placebo i.m. at weekly intervals, from about 4 days before
the expected period (day -4), provided that the level of progesterone (Prog) (on
days -9 to -7) was greater than 10 nmol/l. After placebo no delay in menstruation
or disruption of the succeeding cycle was observed. In 14 of 16 cycles in 14
women given 500 mg 17HPC the withdrawal period was delayed by a few days, and
then followed by highly erratic bleeding over the next 1-3 months. The dose was
therefore reduced to 250 mg 17HPC but the same problem resulted in 8 of 29 cycles
in 16 women (including the above studied in later cycles). Regular cycles were
eventually restored in all cases but in 3 this necessitated treatment with the
contraceptive pill (Microgynon). In most of the post-treatment cycles there was a
progressive and prolonged estradiol (E2) rise, which was not preceded by changes
either in serum FSH concentration or in the LH/FSH ratio nor associated with the
expected positive feedback rise in LH. We conclude that 17HPC disrupts the
following cycle, probably by allowing follicular development while interfering
with positive LH feedback. None of the patients of the double-blind study had
conceived (as evidenced by undetectable hCG levels). Our study confirmed that
this progestogen exerts no direct luteolytic effect. However, in order to
establish the efficacy or otherwise of 17HPC given before the end of the cycle,
women should be selected with a very high index of suspicion of recurrent early
implantation failure or abortion.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 3140580 [PubMed - indexed for MEDLINE]
449: Med Monatsschr Pharm. 1987 Apr;10(4):100-2.
[Herpes zoster (shingles)]
[Article in German]
Cremer H.
PMID: 3587110 [PubMed - indexed for MEDLINE]
450: Clin Pharm. 1986 Dec;5(12):961-76.
Recent advances in antiviral therapy.
Deeter RG, Khanderia U.
Virus replication is described, and the clinical trials and indications for
amantadine, rimantadine, vidarabine, vidarabine phosphate, acyclovir, ribavirin,
and other promising antiviral agents are reviewed. Amantadine and rimantadine are
useful for the treatment and prophylaxis of viral influenza A infections.
Vidarabine is a second-line agent and is effective for the treatment of herpes
simplex encephalitis, neonatal herpes simplex types 1 and 2, and varicella-zoster
infections. Vidarabine phosphate (also known as vidarabine monophosphate) has a
similar spectrum of activity and can be administered in smaller volumes than
vidarabine. Acyclovir has demonstrated clinical efficacy for chickenpox, shingles
(herpes zoster), genital herpes, and other herpes simplex infections. Acyclovir
is also useful for the suppression of herpes infections. Systemically
administered ribavirin is indicated for the treatment of Lassa fever. Aerosol
ribavirin is effective for the treatment of respiratory syncytial virus pneumonia
in children and infants and influenza A infections in adults. Only acyclovir,
amantadine, ribavirin, and vidarabine are used in clinical practice. Vidarabine
phosphate and investigational agents such as rimantadine, ganciclovir (DHPG, BW
B759U), phosphonoformate, and bromovinyl-deoxyuridine (BVDU) need further
investigation.
Publication Types:
Review
PMID: 3542344 [PubMed - indexed for MEDLINE]
451: J Clin Immunol. 1986 Nov;6(6):472-80.
Reduced cellular immunity to varicella zoster virus during treatment for acute
lymphoblastic leukemia of childhood: in vitro studies of possible mechanisms.
Giller RH, Bowden RA, Levin MJ, Walker LJ, Tubergen DG, Hayward AR.
To determine the effect of antileukemic therapy on preexisting immunity to
varicella zoster virus, we studied 20 children with acute lymphoblastic leukemia
maintained in complete continuous remission for greater than 1 year. Cellular
immunity was tested by lymphocyte proliferation in response to varicella antigen.
Antiviral antibody was measured using the fluorescent antibody to membrane
antigen technique. Reduced lymphocyte proliferation was found in 9 of 16
seropositive patients when compared to an age-related control group. On the other
hand, antibody titers in patients receiving chemotherapy remained positive and
were essentially unchanged from pretreatment values. Shingles occurred in two of
nine children with diminished and none of seven patients with normal cellular
immunity, suggesting that proliferative responses to varicella antigen may have
predicative value in identifying patients at risk for viral reactivation.
Additional studies were done to determine if defective antigen presentation or
reduced lymphocyte responder-cell frequency could account for the subnormal
proliferative responses. Intact presentation of varicella antigens by patient
mononuclear cells to parental, virus-specific T-cell blasts suggested that
antigen processing was not defective. However, varicella-specific responder-cell
frequencies measured by limiting dilution analysis were found to be depressed in
most patients, including some with normal proliferative responses. Our findings
indicate that therapy for acute lymphoblastic leukemia in children can be
associated with depressed cell-mediated immunity to varicella zoster virus even
though patients remain seropositive. Further studies suggest that while
monocyte-mediated antigen presentation remains intact, virus-specific lymphocyte
numbers decline and probably contribute to decreased cellular immunity to
varicella zoster virus in children being treated for leukemia.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 3023433 [PubMed - indexed for MEDLINE]
452: J Allergy Clin Immunol. 1986 Apr;77(4):639-45.
Occupational asthma caused by eastern white cedar (Thuja occidentalis) with
demonstration that plicatic acid is present in this wood dust and is the causal
agent.
Cartier A, Chan H, Malo JL, Pineau L, Tse KS, Chan-Yeung M.
A worker developed symptoms of work-related asthma a few weeks after starting to
work in a sawmill where eastern white cedar (Thuja occidentalis) was transformed
into shingles. The diagnosis of occupational asthma was confirmed by monitoring
of peak expiratory flow rates and bronchial responsiveness to histamine off work
and at work, and specific inhalation challenges in the laboratory that
demonstrated an isolated late asthmatic reaction after exposure for 4 hours to
the wood dust. Specific inhalation challenges with western red cedar (thuja
plicata) for 2 hours and plicatic acid (PA) for 7 minutes also caused an isolated
late asthmatic reaction. Elevated specific IgE levels to PA were present.
Antiserum was produced in rabbits that were immunized with PA conjugated to human
serum albumin. With this antiserum in inhibition experiments, cross-reactivity
between western red cedar and eastern white cedar, both belonging to the family
of arborvitae, was found. It is estimated that eastern white cedar contains
approximately half the amount of PA present in western red cedar.
Publication Types:
Case Reports
PMID: 3958393 [PubMed - indexed for MEDLINE]
453: Br Dent J. 1986 Mar 22;160(6):189.
Bilateral shingles.
Cousin GC, Ferguson MM.
Publication Types:
Case Reports
Letter
PMID: 3456780 [PubMed - indexed for MEDLINE]
454: Lancet. 1986 Mar 22;1(8482):682.
Unusual shingles and chickenpox.
Dawson TA, Scott KW.
Publication Types:
Letter
PMID: 2869372 [PubMed - indexed for MEDLINE]
455: 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.
Publication Types:
Case Reports
PMID: 3958530 [PubMed - indexed for MEDLINE]
456: Lancet. 1986 Feb 1;1(8475):273-4.
Shingles clusters.
Palmer SR, Tillett H.
Publication Types:
Letter
PMID: 2868283 [PubMed - indexed for MEDLINE]
457: Lancet. 1985 Dec 21-28;2(8469-70):1433-4.
Clusters of shingles.
[No authors listed]
Publication Types:
Letter
PMID: 2867432 [PubMed - indexed for MEDLINE]
458: 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]
459: Lancet. 1985 Nov 16;2(8464):1105-6.
Outbreaks of shingles.
[No authors listed]
Publication Types:
Editorial
PMID: 2865573 [PubMed - indexed for MEDLINE]
460: 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]
461: Med Sestra. 1985 Mar;44(3):39-43.
[Herpes zoster (shingles)]
[Article in Russian]
Malkova EV, Malkov GF.
PMID: 3846735 [PubMed - indexed for MEDLINE]
462: Emerg Med Serv. 1985 Mar-Apr;14(2):48.
Chickenpox, shingles and EMS.
West KH.
PMID: 10269642 [PubMed - indexed for MEDLINE]
463: 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.
Publication Types:
Clinical Trial
Controlled Clinical Trial
Research Support, Non-U.S. Gov't
PMID: 3912970 [PubMed - indexed for MEDLINE]
464: Med Pr. 1985;36(2):123-30.
[Ototoxic factors requiring consideration in the diagnosis of occupational
hearing loss]
[Article in Polish]
Grzesik J, RzymeЕ‚ka S.
In the practice of diagnosing occupational deafness resulting from noise effects
of factors determining workers' hearing, such as living conditions, working
conditions, nutritional and other habits, diseases and their therapy, are often
neglected. Discussed in the paper are the significance and ototoxic effects of
such factors as: aminoglycoside antibiotics, diuretics, salicylic acid
derivatives, fenacetin, quinine, fluorine compounds, cytotoxic drugs, chemical
compounds other than drugs (carbon monoxide, carbon disulphide, lead, organic
solvents), ethyl alcohol, diseases (abdominal typhus, bacillary dysentery,
diphtheria, brucellosis, epidemic parotiditis, poliomyelitis, rubella, aural
shingles, syphilis, diabetes mellitus, chronic renopathies, hypothyroidism,
serologic conflict, pigmentary retinitis). Exposure to intense noise is more and
more frequently juxtaposed with the impact of the mentioned factors. If
industrial physicians get aware of this association the prevention of deafness
and reliability of treatment may be largely promoted.
Publication Types:
English Abstract
Review
PMID: 3906348 [PubMed - indexed for MEDLINE]
465: 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.
Publication Types:
Case Reports
PMID: 6097567 [PubMed - indexed for MEDLINE]
466: Plant Physiol. 1984 Mar;74(3):705-710.
Effects of Glycolate Pathway Intermediates on Glycine Decarboxylation and Serine
Synthesis in Pea (Pisum sativum L.).
Shingles R, Woodrow L, Grodzinski B.
Department of Horticultural Science, University of Guelph, Guelph, Ontario N1G
2W1, Canada.
Glycine decarboxylation and serine synthesis were studied in pea (Pisum sativum
L.) leaf discs, in metabolically active intact chloroplasts, and in mitochondria
isolated both partially by differential centrifugation (i.e. ;crude') and by
further purification on a Percoll gradient. Glycolate, glyoxylate, and formate
reduced glycine decarboxylase activity ((14)CO(2) and NH(3) release) in the crude
green-colored mitochondrial fractions, and in the leaf discs without markedly
altering serine synthesis from [1-(14)C]glycine. Glycolate acted because it was
converted to glyoxylate which behaves as a noncompetitive inhibitor (K(i) = 5.1
+/- 0.5 millimolar) on the mitochondrial glycine decarboxylation reaction in both
crude and Percoll-purified mitochondria. In contrast, formate facilitates glycine
to serine conversion by a route which does not involve glycine breakdown in the
crude mitochondrial fraction and leaf discs. Formate does not alter the
conversion of two molecules of glycine to one CO(2), one NH(3), and one serine
molecule in the Percoll-purified mitochondria. In chloroplasts which were unable
to break glycine down to CO(2) and NH(3), serine was labeled equally from
[(14)C]formate and [1-(14)C]glycine. The maximum rate of serine synthesis
observed in chloroplasts is similar to that in isolated metabolically active
mitochondria. Formate does not appear to be able to substitute for the one-carbon
unit produced during mitochondrial glycine breakdown but can facilitate serine
synthesis from glycine in a chloroplast reaction which is probably a secondary
one in vivo.
PMID: 16663485 [PubMed - as supplied by publisher]
467: Gastrointest Endosc. 1984 Feb;30(1):26-7.
Shingles esophagitis: endoscopic diagnosis in two patients.
Gill RA, Gebhard RL, Dozeman RL, Sumner HW.
Publication Types:
Case Reports
PMID: 6706086 [PubMed - indexed for MEDLINE]
468: Lancet. 1984 Jan 14;1(8368):103-4.
Shingles in seven homosexuals.
Rowland Payne CM, Farthing C, Byrom N, Staughton RC.
Publication Types:
Letter
PMID: 6140400 [PubMed - indexed for MEDLINE]
469: 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.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 6650330 [PubMed - indexed for MEDLINE]
470: Nature. 1983 Dec 1-7;306(5942):478-80.
Varicella-zoster virus DNA in human sensory ganglia.
Gilden DH, Vafai A, Shtram Y, Becker Y, Devlin M, Wellish M.
Varicella-zoster virus (VZV) causes chickenpox and shingles. Clinical and
epidemiological evidence indicates that following an episode of childhood
chickenpox (varicella), VZV becomes latent, presumably in dorsal root ganglia,
and is reactivated many years later to produce shingles (zoster) in adults. VZV
has been demonstrated in ganglia by electron microscopy and by indirect
immunofluorescence, and infectious viral particles have been isolated from
acutely infected ganglia of patients who died of disseminated VZV infection.
However, VZV has not been detected in the ganglia of humans without recent
exposure to VZV. Tissue culture explant methods that have been successful in the
isolation of herpes simplex virus from ganglia have so far failed in the
isolation or reactivation of VZV from trigeminal and other dorsal root ganglia.
We describe here the detection of VZV DNA sequences in an acutely infected human
sacral ganglion and in normal trigeminal ganglia. These findings support the
hypothesis that VZV is latent in normal human ganglia.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 6316159 [PubMed - indexed for MEDLINE]
471: 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.
Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
PMID: 6139571 [PubMed - indexed for MEDLINE]
472: J Assoc Physicians India. 1983 Oct;31(10):617-8.
Interesting new findings regarding the age old shingles.
Sainani GS, Deshpande DV.
Publication Types:
Editorial
PMID: 6671929 [PubMed - indexed for MEDLINE]
473: 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.
Publication Types:
Clinical Trial
Randomized Controlled Trial
Review
PMID: 6355047 [PubMed - indexed for MEDLINE]
474: N C Med J. 1983 Aug;44(8):500-1.
Shingles.
Heald PW, Burton CS, Callaway JL.
PMID: 6579360 [PubMed - indexed for MEDLINE]
475: Aust Fam Physician. 1983 Jul;12(7):500.
Herpes zoster (shingles).
Murtagh JE.
PMID: 6639484 [PubMed - indexed for MEDLINE]
476: 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.
Publication Types:
Clinical Trial
English Abstract
PMID: 6347078 [PubMed - indexed for MEDLINE]
477: J La State Med Soc. 1983 Jan;135(1):34-7.
Just another case of "shingles"?
Morse RH.
Publication Types:
Case Reports
PMID: 6405001 [PubMed - indexed for MEDLINE]
478: J La State Med Soc. 1982 Dec;134(9):30-2, 34.
Chronic pain review. A surprising case of "shingles".
Morse RH.
Publication Types:
Case Reports
PMID: 7175341 [PubMed - indexed for MEDLINE]
479: Vet Rec. 1982 Oct 2;111(14):330.
Canine 'shingles'.
Gravestock JD.
Publication Types:
Case Reports
Letter
PMID: 7147650 [PubMed - indexed for MEDLINE]
480: Hosp Pract (Off Ed). 1982 Oct;17(10):166, 171, 174 passim.
Shingles, dyspnea, and wild irrational behavior.
Kandel G, Aberman A.
Publication Types:
Case Reports
PMID: 6811401 [PubMed - indexed for MEDLINE]
481: Plant Physiol. 1982 Jun;69(6):1435-1438.
Alternative Pathway Respiration and Lipoxygenase Activity in Aged Potato Slice
Mitochondria.
Shingles RM, Arron GP, Hill RD.
Department of Plant Science, University of Manitoba, Winnipeg, Canada R3T 2N2.
Mitochondrial preparations isolated from aged white potato (Solanum tuberosum L.)
slices exhibited classical cyanide-insensitive O(2) uptake which was inhibited by
salicylhydroxamic acid and tetraethylthiuram disulfide (disulfiram). These
mitochondria also possessed lipoxygenase activity, as determined by O(2) uptake
in the presence of 4 millimolar linoleic acid. Purification of the mitochondrial
preparation on a continuous Percoll gradient resulted in a large decrease in
lipoxygenase activity whereas cyanide-insensitive (disulfiram sensitive) O(2)
consumption was still observed. These data indicate that cyanide-insensitive O(2)
consumption in mitochondrial preparations isolated from aged white potato slices
is of mitochondrial origin and not due to lipoxygenase contamination.
PMID: 16662418 [PubMed - as supplied by publisher]
482: 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.
Publication Types:
Clinical Trial
Controlled Clinical Trial
English Abstract
PMID: 6750532 [PubMed - indexed for MEDLINE]
483: Am J Hosp Pharm. 1982 Apr;39(4):612-8.
Design of a revised controlled substances distribution system.
Somani SM, Giese RM, Roberts AW.
A controlled substances distribution system that uses daily audit and disposition
forms for three different groups of drug products is described. In the previously
used system, only Schedule II drugs were controlled, using shingled proof-of-use
forms for each product. All other controlled substances were dispensed like
regular prescriptions. Accountability, record retrieval, and security weaknesses
led to the development of a new system. The new system has a separate audit and
disposition form for Schedule II injections, Schedule II orals and miscellaneous
drugs, and Schedule III and IV oral and injectable drug products. Each form lists
the most frequently prescribed products in the category. Nurses record daily
shift counts on the bottom of the form. Twenty-one shingles are attached to the
form that are similar to the shingles on the proof-of-use forms of the old
system; these serve as patient charge slips. Each nursing station uses at least
one of each form every day. Pharmacy reviews these forms daily for discrepancies
and to determine the restocking needs of the nursing stations. A quality
assurance program to assess the performance of the new system is described. Use
of the daily audit and disposition forms for controlled substances combines
accountability, security, and efficiency for nursing personnel with an effective
charging mechanism.
PMID: 7081238 [PubMed - indexed for MEDLINE]
484: Practitioner. 1982 Mar;226(1365):531-2.
Shingles in diabetes mellitus.
McCulloch DK, Fraser DM, Duncan LP.
PMID: 7088846 [PubMed - indexed for MEDLINE]
485: J Med Assoc State Ala. 1982 Mar;51(9):43-9.
Shingles, herpes, sex and mononucleosis.
Clemmons LH.
Publication Types:
Letter
PMID: 7069308 [PubMed - indexed for MEDLINE]
486: 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]
487: Feldsher Akush. 1981;46(10):55-7.
[Shingles: herpes zoster]
[Article in Russian]
Sagalov GM.
Publication Types:
Case Reports
PMID: 6913509 [PubMed - indexed for MEDLINE]
488: Nursing (Lond). 1979 Jun;(3):115, 125.
Photo test: shingles.
[No authors listed]
Publication Types:
Case Reports
PMID: 317145 [PubMed - indexed for MEDLINE]
489: Br Med J. 1979 Mar 24;1(6166):818.
Shingles: a belt of roses from Hell.
Schreuder M, Fothergill WT.
Publication Types:
Letter
PMID: 435807 [PubMed - indexed for MEDLINE]
490: Br Med J. 1979 Mar 24;1(6166):818.
Shingles: a belt of roses from Hell.
Juel-Jensen B.
Publication Types:
Letter
PMID: 435806 [PubMed - indexed for MEDLINE]
491: Br Med J. 1979 Feb 17;1(6161):490.
Shingles: a belt of roses from hell.
[No authors listed]
Publication Types:
Letter
PMID: 427427 [PubMed - indexed for MEDLINE]
492: Br Med J. 1979 Feb 3;1(6159):346.
Shingles: a belt of roses from Hell.
[No authors listed]
Publication Types:
Letter
PMID: 421119 [PubMed - indexed for MEDLINE]
493: 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.
Publication Types:
Case Reports
English Abstract
PMID: 229550 [PubMed - indexed for MEDLINE]
494: Br Med J. 1979 Jan 6;1(6155):5.
Shingles: a belt of roses from Hell.
[No authors listed]
Publication Types:
Editorial
PMID: 216456 [PubMed - indexed for MEDLINE]
495: N Engl J Med. 1977 Apr 7;296(14):824.
Real vs. pseudo-shingles.
Siegel AJ.
Publication Types:
Letter
PMID: 840294 [PubMed - indexed for MEDLINE]
496: 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]
497: 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.
Publication Types:
Case Reports
PMID: 63042 [PubMed - indexed for MEDLINE]
498: Vestn Dermatol Venerol. 1976 Aug;(8):71-4.
[Shingles as a provoking factor in psoriasis]
[Article in Russian]
Lipets ME, Gavrikov VV, Shibaeva LN.
Publication Types:
Case Reports
English Abstract
PMID: 983286 [PubMed - indexed for MEDLINE]
499: J Natl Cancer Inst. 1976 May;56(5):891-8.
Epidemiology of diseases in adult males with leukemia.
Gibson R, Graham S, Lilienfeld A, Schuman L, Levin M, Swanson M.
In the Tri-State Leukemia Survey, the history of diseases in 605 adult male
leukemia cases 15 years and older and in 668 adult male population controls was
examined. These diseases occurred at least 1 year before leukemia was diagnosed.
The data were based on respondents' answers that the disease was diagnosed by a
physician; the respondent was either the subject or his spouse. Of 30 diseases
studied, 7 showed an excess among the patients with leukemia: infectious
hepatitis, eczema, psoriasis, diabetes, arthritis and rheumatism, heart disease,
and ankylosing spondylitis. Mumps had a lower reported occurrence among the
cases, whereas pneumonia was less frequent in acute lymphatic cases than in
population controls. Three diseases occurred significantly less in controls than
in persons with specific histologic types of leukemia. Our data revealed a more
frequent history of herpes zoster (shingles) in chronic lymphatic leukemia, more
hives in acute chronic myeloid cases, and meningitis in acute myeloid leukemia.
When we only considered the patients' responses, more of them admitted having had
acne than did our controls. The remaining diseases--childhood viral diseases,
infectious mononucleosis, smallpox, typhoid fever, dysentery, scarlet fever,
tuberculosis, asthma, hay fever, and goiter did not occur more frequently in
cases than in controls. The findings were consistent with evidence from previous
laboratory and clinical studies. The increased occurrence of infectious hepatitis
in our case series is consistent with the findings of other studies showing an
increased frequency of Australia antigen in patients with hepatitis, leukemia,
and Down's syndrome.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
PMID: 994201 [PubMed - indexed for MEDLINE]
500: Am J Chin Med (Gard City N Y). 1976 Autumn;4(3):219-37.
A contribution to our knowledge of Leonurus L., i-mu-ts'ao, the Chinese
motherwort.
Hu S.
This article deals with the ethnobotanical aspects of the Chinese motherwort.
Since time immemorial the Chinese people have used various parts of motherwort to
meet different physical needs. By the time a written language was developed and
the medical uses were recorded. , motherwort was treated as an article of
superior quality. At present, under the name of i-mu-ts'ao, the plant is used for
improving bloodflow both by official physicians and herbal practitioners
throughout the country as well as by villagers in isolated areas. According to
Chinese classical literature on materia medica, the early uses were limited to
the parts of the plant which met the most obvious needs of the prehistorical
people in their struggle for existence-food and pain reliever. Evidently, in
their search for food, the ancient people found that the four nutlets contained
in the dry and spinose calyx of the Chinese motherwort resemble the seasame seed
in size and oil content. They gathered them and used them for food in similar
manner as with the sesame. Consequently, they discovered the good effects to the
eyesight, the improvement of strength, and the uplift of spirit. These
discoveries led to the use of the seed of the species as an eye medicine for
improving the eyesight, and as a tonic for the increase of strength and the
elevation of spirit. Contagious skin diseases caused serious problems for the
ancient people. The use of the leafy shoot for a bath to release the discomfort
of itches and shingles was also recorded in the 42-word first medicinal record of
the species in the earliest known Chinese materia medica-the Shen-nung
pen-ts'ao-ching. Translators of the Chinese classics have included the records of
i-mu-ts'ao. According to my knowledge, these works are all partial translations
with the selections of the medicinal properties and the omissions on the methods
of preparation. They have the outline and abandon the details. Consequently most
of them are not clear. In order to provide complete information on the
discoveries of the ancient Chinese people on the uses of i-mu-ts'ao, all the
records up to the end of the sixteenth century are organized and translated under
the following headings: (1) ecological and morphological observations; (2)
preparations; (3) physical and therapeutical properties; (4) special
prescriptions for internal and external uses-including pills for pregnant women,
for mothers post partum, as an emmenagogue, and as a corrective agent, condensed
liquid, powder, fresh juice, baby bath and washes, poultices, charred shoots,
gargles, drops and cakes; (5) other economic uses-including cosmetics and food;
and (6) etymology. The distribution of i-mu-ts'ao is significant in
photogeography and in the nomenclature of the species. I-mu-ts'ao was purposely
introduced from South China to Linnaeus in Sweden before the publication of the
Species Plantarum in 1753. Linnaeus planted the seed in the botanical garden of
the University of Uppsala...
PMID: 970356 [PubMed - indexed for MEDLINE]
501: Ann Otolaryngol Chir Cervicofac. 1975 May-Jun;92(4-5):229-34.
[Facial paralysis in children]
[Article in French]
Muler H, Paquelin F, Cotin G, Luboinski B, Henin JM.
Facial paralyses in children may be grouped under headings displaying a certain
amount of individuality. Chronologically, first to be described are neonatal
facial paralyses. These are common and are nearly always cured within a few days.
Some of these cases are due to the mastoid being crushed at birth with or without
the use of forceps. The intra-osseous pathway of the facial nerve is then
affected throughout its length. However, a cure is often spontaneous. When this
desirable development does not take place within three months, the nerve should
be freed by decompressive surgery. The special anatomy of the facial nerve in the
new-born baby makes this a delicate operation. Later, in all stages of acute
otitis, acute mastoiditis or chronic otitis, facial paralysis can be seen.
Treatment depends on the stage reached by the otitis: paracentesis,
mastoidectomy, various scraping procedures, and, of course, antibiotherapy. The
other causes of facial paralysis in children are very much less common: a frigore
or viral, traumatic, occur ring in the course of acute poliomyelitis, shingles or
tumours of the middle ear. To these must be added exceptional causes such as
vitamin D intoxication, idiopathic hypercalcaemia and certain haemopathies.
Publication Types:
English Abstract
PMID: 1217818 [PubMed - indexed for MEDLINE]
502: 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.
PMID: 4352254 [PubMed - indexed for MEDLINE]
503: Lancet. 1973 Mar 3;1(7801):481.
The windmills of shingles.
Macrae AD.
PMID: 4120386 [PubMed - indexed for MEDLINE]
504: Lancet. 1973 Feb 17;1(7799):369.
"Catching" shingles?
Slack PM, Taylor-Robinson D.
PMID: 4121953 [PubMed - indexed for MEDLINE]
505: 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]
506: 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]
507: Lancet. 1972 Jan 29;1(7744):263.
Causation of shingles.
Thomas M, Robertson WJ.
PMID: 4109722 [PubMed - indexed for MEDLINE]
508: Lancet. 1972 Jan 15;1(7742):151.
Exogenous or endogenous causation of shingles.
Taylor-Robinson D, Slack PM.
PMID: 4109010 [PubMed - indexed for MEDLINE]
509: 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]
510: J R Coll Gen Pract. 1970 Dec;20(101):323-7.
The natural history of shingles. Events associated with reactivation of
varicella-zoster virus.
Juel-Jensen BE.
PMID: 5533234 [PubMed - indexed for MEDLINE]
511: 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.
PMID: 4322005 [PubMed - indexed for MEDLINE]
512: Appl Microbiol. 1970 May;19(5):872-4.
Fungal disfigurement of paper, and soft rot of cedar shingles.
Eveleigh DE.
Disfiguration of paper by Cladosporium cladosporioides is described, and the
association between "soft rot" fungi and the greying of cedar shingles in marine
locations is reported.
PMID: 5463581 [PubMed - indexed for MEDLINE]
513: Z Haut Geschlechtskr. 1970 Mar 15;45(6):Suppl:29-36.
[Virus diseases of the external female genitalia. 2. Zoster (GГјrtelrose, zona,
shingles)]
[Article in German]
Grimmer H.
PMID: 5513210 [PubMed - indexed for MEDLINE]
514: Br Med J. 1970 Feb 14;1(5693):382-3.
Paralysed hemidiaphragm and shingles.
[No authors listed]
PMID: 5434652 [PubMed - indexed for MEDLINE]
515: Zh Nevropatol Psikhiatr Im S S Korsakova. 1969;69(4):525-9.
[A study of the therapeutic effect of deoxyribonuclease in shingles (herpes
zoster)]
[Article in Russian]
Boldyrev LP, Salganik RI.
PMID: 5796670 [PubMed - indexed for MEDLINE]
516: Nurs Times. 1968 Nov 1;64(44):1478-9.
Shingles (herpes zoster).
Geddes AM.
PMID: 5685340 [PubMed - indexed for MEDLINE]
517: Lancet. 1968 Jul 20;2(7560):170-1.
Shingles.
Elliott FA.
PMID: 4173290 [PubMed - indexed for MEDLINE]
518: Lancet. 1968 Jun 29;1(7557):1427.
Shingles.
Phillips R.
PMID: 4173011 [PubMed - indexed for MEDLINE]
519: Lancet. 1968 Jun 22;1(7556):1370.
Shingles.
Wigglesworth R.
PMID: 4172670 [PubMed - indexed for MEDLINE]
520: Lancet. 1968 Jun 8;1(7554):1242.
Shingles.
[No authors listed]
PMID: 4172788 [PubMed - indexed for MEDLINE]
521: 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]
522: Rocky Mt Med J. 1966 Dec;63(12):37-9.
Shingles and chickenpox.
Ratcliff RG.
Publication Types:
Case Reports
PMID: 5981133 [PubMed - indexed for MEDLINE]
523: Dis Chest. 1965 Apr;47(4):451.
A renewed plea for the isolation of shingles. Report of a case.
Weingarten CM.
Publication Types:
Case Reports
PMID: 5836927 [PubMed - indexed for MEDLINE]
524: Med World. 1961 May;94:421-3.
B12 peptide in shingles and chickenpox.
JOLLES KE.
PMID: 13790421 [PubMed - indexed for MEDLINE]
525: Lancet. 1954 Dec 25;267(6852):1299-302.
Studies on shingles: is the virus ordinary chickenpox virus?
SIMPSON RE.
PMID: 13222825 [PubMed - OLDMEDLINE]
526: 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]