We present a case of multipathogen respiratory infection with severe acute respiratory syndrome coronavirus 2, varicella zoster virus, and polymicrobial tracheobronchitis in a 48-year-old Caucasian male hospitalized after traumatic brain injury. The patient tested positive for severe acute respiratory syndrome coronavirus 2 infection upon admission. During his stay in the intensive care unit, the patient developed a vesicular exanthema along with respiratory failure and signs of septic shock.
Virus De La Varicela Zoster Pdf Download
This case of an adult presenting with severe acute respiratory syndrome coronavirus 2 infection and simultaneous primary varicella zoster virus infection illustrates the importance of considering coinfections in patients with coronavirus disease 2019 with unusual clinical manifestations.
Herpes zoster (HZ) is caused by the reactivation of latent infection with varicella zoster virus (VZV) after primary varicella infection. The condition is characterised by the localised eruption of vesicular lesions following the trajectory of a sensory nerve as well as pain and inflammation of the affected nerve root [1].
El herpes zóster (culebrilla) es una erupción cutánea dolorosa causada por el virus varicela-zóster (VZV). Es el mismo virus que causa la varicela. Después de que una persona ha tenido varicela, el virus permanece inactivo en las células nerviosas. El virus puede volver a activarse años más tarde. En ese caso, aparecen una erupción roja o pequeñas ampollas generalmente en una parte del cuerpo y se propagan por las vías nerviosas donde el virus estaba inactivo. En algunas ocasiones, incluso después de que ha desaparecido la erupción, el dolor puede continuar durante un período prolongado de tiempo, una complicación llamada neuralgia posherpética (NPH). Las personas que reciben la vacuna contra la varicela también tienen un riesgo pequeño de tener herpes zóster, aunque parece ser inferior al riesgo luego de una infección de varicela. Las personas con un sistema inmunológico débil tienen mayor riesgo de contraer culebrilla. Casi la mitad de los casos ocurre en personas mayores de 60 años.
Varicella-zoster virus (VZV) is one of the eight herpes viruses known to cause human infections and is the second cause of acute encephalitis in France after herpes simplex virus (HSV) 1 and 2 [2, 3, 9]. Its incidence has grown over the last decade [10]. The most common neurologic symptoms of VZV infection are meningoencephalitis, cerebellitis, stroke, myelopathy and retinitis.
Neurologic outcome assessed with the modified Rankin Scale 6 months and 1 year after ICU discharge. Missing data: 5 (9%) patients at 6 months and 5 (9%) patients at 1 year. ICU: intensive care unit; VZV: varicella-zoster virus
A recent study conducted in France on HSV encephalitis in the ICU setting found that patients had a median age of 64 years and 19% were immunocompromised [5]. In contrast, patients with VZV encephalitis in our study were younger (median age 53 years), and almost 80% were immunocompromised. Our results are in line with a recent nationwide Danish study where almost 40% of patients with VZV encephalitis had underlying immunosuppression [16]. VZV encephalitis results from reactivation of the virus located in neurons of dorsal root, autonomic and cranial ganglia, or less frequently from a primary infection [17]. Around 50% of herpes zoster cases occur in subjects with reduced cell-mediated immunity [18, 19]. Our results suggest that immunocompromised patients have an increased risk of developing more severe forms of VZV encephalitis [20]. Moreover, the high proportion of immunocompromised patients in our study could explain that most of them developed a disseminated form of the disease with typical chickenpox skin rash. Moreover, a recent study identified TLR3 mutations in patients with VZV and HSV encephalitis, suggesting a potential host factor for these diseases [21]. We cannot exclude that non-immunocompromised patients in our cohort had such risk factors for VZV encephalitis.
Varicella zoster virus (VZV) causes chicken-pox in the primary infection. In elderly or immunosuppressed patients, reactive VZV can cause herpes zoster after latency [187]. During the latency, VZV downregulates the surface expression of the NKG2D ligands of ULBP2 and ULBP3, which reduce the activation of natural killer cells in the presence of VZV [188].
To analyze the clinical presentation and complications of varicella zoster virus (VZV) infection in children with rheumatic diseases treated with immunosuppressive medication such as biological disease-modifying antirheumatic drugs (bDMARDs) and/or conventional disease-modifying antirheumatic drugs (cDMARDs), and to analyze the therapeutic approach to VZV infections with respect to the concomitant immunosuppressive treatment.
In the absence of a universal childhood immunization program for varicella zoster virus (VZV), VZV infection is widely spread in the Swiss pediatric population. By the age of 14 years, 95 % of children are seropositive for VZV [1]. The clinical features of VZV infection are determined by primary infection leading to varicella (chickenpox) and endogenous reactivation leading to herpes zoster (shingles). The most frequent complications of varicella are secondary infections, notably cellulitis, abscesses, pneumonia, sepsis and fasciitis, mainly caused by Staphylococcus aureus or group A β-hemolytic streptococci. Complications of the central nervous system may present as cerebellar ataxia, meningoencephalitis or cerebral vasculitis [2]. 2ff7e9595c
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