Risultati per: Herpes Zoster

Genital herpes simplex virus (HSV) infections are among the most common sexually transmitted infections encountered by humans and, in 2018, were estimated to occur in approximately 27% of US adults. There is no cure for HSV infection; consequently, infection can be transmitted from individual to individual, most often because of asymptomatic viral shedding. Thus, the reservoir of individuals infected with HSV continues to increase.

Circulation, Volume 146, Issue Suppl_1, Page A12435-A12435, November 8, 2022. Introduction:We emphasise the role of imaging as illustrated by the case of a 71-year-old male who presented with acute pericarditis one day after receiving a Varicella Zoster Virus (VZV) Vaccination. Although active VZV infection itself is recognised as an uncommon trigger for pericarditis, and myopericarditis following several live attenuated vaccines, its occurrence specifically following VZV vaccination is rare.Case Presentation:This gentleman was previously fit and well prior with no significant comorbidity or drug allergies. Clinically, we suspected VZV vaccine-induced pericarditis in this case due to the short temporal relationship between vaccination and symptom onset and absence of other known infectious and non-infectious causes of pericarditis. This was in addition to characteristic chest pain, fever, sweating, electrocardiogram (clear PR depression and subtle concave ST elevation) and imaging (echocardiography and Cardiac MRI) features.Imaging Results:Pulmonary embolism was excluded by CT pulmonary angiography, but this scan did reveal a large, global pericardial effusion. Prompt transthoracic echocardiogram categorised the pericardial effusion as small and did not show any signs of cardiac tamponade. Cardiac MRI imaging demonstrated a large pericardial effusion but did not show any overt myocardial oedema, inflammation or fibrosis, consistent with a low high-sensitivity troponin I. Interestingly, the MRI did not reveal any convincing pericardial oedema or fibrosis acutely, which might be expected in pericarditis.Transthoracic echocardiography was important in excluding features of tamponade and helped confirm the diagnosis of acute pericarditis by clearly demonstrating the pericardial effusion. A Cardiac MRI was essential in excluding co-existent myocarditis and infarction.Conclusions:Acute pericarditis should be considered in patients presenting with chest pain after receiving the VZV vaccination and patients should be made aware of this rare side effect prior to receiving their vaccination. The patient in this case study responded well to symptomatic treatment with analgesia and colchicine, suggesting that anti-viral therapy is not required for VZV related pericarditis.

Circulation, Volume 146, Issue Suppl_1, Page A13090-A13090, November 8, 2022. Introduction:Orthotopic heart transplantation (OHT) increases the risks of varicella-zoster reactivation, and severe complications may arise due to infection in the setting of active immunosuppression. Complications include meningitis, facial nerve palsy (known as Ramsay Hunt Syndrome), and bacterial superinfection. When severe bacterial ear infections spread to the petrous apex, facial pain accompanied by otitis media and abducens nerve palsy may also occur, classically known as Gradenigo Syndrome.Case Report:We present a case of a patient 15 months post OHT who came in with left-sided facial droop and pain, abducens palsy, crusting facial rash, and ear swelling. Imaging revealed necrotizing otitis externa, with associated otitis media, petrous apicitis, and signs suggestive of encephalitis. A viral panel resulted positive for zoster infection, with superimposed methicillin-resistant staphylococcus aureus infection. Despite treatment with antibiotics and antivirals, the patient’s mentation declined, with subsequent lumbar puncture revealing zoster meningoencephalitis. The patient’s mycophenolate mofetil (MMF) immunosuppression was suspended, and he was continued solely on therapeutic tacrolimus. His antiviral was switched to intravenous acyclovir and he was continued on six weeks of antibiotic therapy. The patient demonstrated resolution of his acute infection, however he continues to have residual facial and abducens nerve palsies. On discharge, the patient was resumed on MMF without any cardiac complications.Conclusions:This is the first documented case of Ramsay Hunt Syndrome, complicated by Gradenigo Syndrome and varicella-zoster virus meningoencephalitis in an OHT recipient. Our patient’s immunosuppression level was the most important factor leading to the concurrence of these novel complications. Physicians should consider and assess for symptoms of these potential sequelae in all transplant patients, and carefully manage immunosuppressive agents to allow for resolution of the infection, while avoiding rejection. While residual neurologic deficits may be challenging to manage, this case demonstrated successful treatment of these complications while avoiding significant cardiac sequelae.

Objective
Viral infection is an exogenous factor for Sjögren’s syndrome (SS). The relationship between herpes zoster infection and the ensuring risk of SS has remained unclear. This study investigated the association between a history of herpes zoster infection and the risk of SS through a nationwide population-based case–control study.

Design
Retrospective case–control study.

Setting
General population of Taiwan.

Data source
2003–2013 National Health Insurance Research Database of Taiwan.

Participants
We identified all patients with newly diagnosed SS between 1 January 2007 and 31 December 2012 without a history of rheumatoid arthritis or systemic lupus erythematosus as the SS group.

Controls
We randomly selected patients without SS between 1 January 2003 and 31 December 2012 and matched 1:5 with controls based on index year, age and sex.

Main outcome measure
Conditional logistic regression analysis to examine the association between a history of herpes zoster and the risk of SS.

Results
The study included 5751 patients with SS and 28 755 matched controls. The risk of SS was significantly associated with a history of herpes zoster (model A (adjusted for Charlson Comorbidity Index (CCI) (excluding connective tissue disease, CTD)): OR 1.89; 95% CI 1.71 to 2.08; model B (adjusted for comorbidities used to calculate CCI (excluding CTD)): OR 1.90; 95% CI 1.72 to 2.10), in particular if the interval from the last visit for herpes zoster infection to the index date was