Herpes zóster en lactantes. Presentación de tres casos / Herpes zoster in infants. Three cases report

RESUMEN El herpes zóster es una afección infrecuente en lactantes, con una incidencia de 0,74/1 000 habitantes. Se produce por la reactivación del virus de la varicela zóster, tras una primoinfección por varicela. Puede ocurrir intraútero, por lo que resulta relevante conocer los antecedentes maternos. El diagnóstico es clínico y si se realiza de forma adecuada reduce el riesgo de complicaciones. El tratamiento en los niños es sintomático, porque su evolución es más favorable que en los adultos. Debido a la rareza de esta entidad, se presentan tres casos de herpes zóster en lactantes de 4, 6 y 11 meses de edad, que acudieron con lesiones y evolución típica de esta enfermedad al Hospital Pediátrico Provincial Docente Eliseo Noel Caamaño, de Matanzas, entre septiembre y octubre de 2017 (AU).

ABSTRACT Herpes zoster is an uncommon affection in infants, with an incidence of 0.74/1 000 inhabitants. It is produced by the reactivation of the varicella-zoster virus, after a primary infection by varicella. This can occur inside the uterus, making it relevant to know maternal antecedents. The diagnosis is clinical, and if it is made in an appropriate way, reduces complication risk. The treatment in children is symptomatic because its evolution is more favorable than in adults. Due to the rareness of this entity, we present three cases of herpes zoster in nurslings aged 4, 6 and 11 moths who assisted the Teaching Pediatric Hospital Eliseo Noel Caamaño, of Matanzas, with lesions and typical evolution of this disease in the period September-October 2017 (AU).

Herpes zóster. Actualización y manejo / Herpes zoster. Management and treatment update

El herpes zóster es una enfermedad infecciosa producida por el virus de la varicela zóster, caracterizada por la aparición de vesículas que suelen presentarse en una disposición metamérica. Su incidencia se encuentra en aumento y es un motivo de consulta frecuente en la práctica cotidiana. En este artículo se ofrece información actualizada acerca de su diagnóstico, tratamiento y prevención, así como sobre otros aspectos controvertidos de su manejo.

Herpes zoster is an infectious disease caused by varicella zoster virus, characterized by the development of vesicles, which usually present with a metameric arrangement. Its incidence is increasing and is a frequent reason for consultation in daily practice. This article offers updated information on its diagnosis, treatment and prevention, as well as controversial aspects of the management of this pathology.

Segmental Zoster Paresis:Report of One Case and Literature Review / 中国医学科学院学报

Segmental zoster paresis(SZP)is a rare complication in herpes zoster infection,with its symptoms often neglected due to the co-existence of pain.Here we reported a case of SZP.Also,we analyzed 42 Chinese SZP cases in literature,which revealed that the male to female ratio of SZP patients was 13∶8,and the median age of disease onset was 65 years.The most commonly affected region is upper limb.The diagnosis depends mainly on typical medical history and clinical symptoms.Although there is no definite therapy for SZP,the antiviral therapy is the most commonly used treatment,which achieved complete recovery in 78.6% of the patients and partial recovery in 14.3% of the patients.

Herpes zóster diseminado: caso clínico y revisión bibliográfica / Disseminated herpes zoster: clinical case and literature review

Herpes zoster classical clinical presentation is the acute onset of multiple vesicles over an erythematous base, disposed over one or two dermatomes with up to 20 vesicles located outside the main dermatome. Disseminated herpes zoster is an atypical and rare form of presentation of herpes zoster, which manifests with lesions beyond the described territory. It occurs mainly in patients with some type of cellular immunosuppression. The diagnosis is made with the medical history and physical examination, however, it should be confirmed with laboratory tests. Treatment must be initiated early to avoid serious complications, such as bacterial infection of the lesions, post-herpetic neuralgia, or even central nervous system involvement. The drug of choice is intravenous acyclovir that must be maintained until the cessation of the appearance of new lesions, and then switch to its oral presentation for another 5-7 days. Disseminated herpes zoster mortality rounds 5-15%. There are varicella-zoster virus vaccines, that have been shown to reduce the incidence of herpes zoster relapses, however its utility to disseminated herpes zoster is uncertain and further studies are required. We present the case of a male patient with a history of rheumatoid arthritis who consults with multiple vesicles distributed throughout his body. (AU)

Detección molecular del gen de la glicoproteína B del virus herpes felino / Molecular detection of glycoprotein B from feline herpesvirus

El virus herpes felino tipo 1 genera múltiples problemas y el gato termina con consecuencias que afectan su futura calidad de vida. Este virus está distribuido en todo el mundo y es de fácil transmisión y dado que es un patógeno latente, continúa propagándose sin control a toda la población de gatos. El diagnóstico se basa en los signos clínicos, existiendo hoy en Chile solo un método de diagnóstico de laboratorio específico, implementado para identificar el agente, que no se usa regularmente en la clínica de animales pequeños. Así, el tratamiento y diagnóstico generalmente se basan en el conocimiento y la experiencia del médico veterinario, sin dejar una confirmación real sobre qué agente está causando los síntomas. Esta investigación propuso un método de diagnóstico molecular alternativo a la detección del gen de la timidina quinasa viral, para el cual se seleccionaron gatos menores de 1 año de edad, con síntomas compatibles con una infección con el virus del herpes felino. El método de la Reacción en Cadena de la Polimerasa (PCR) se utilizó para detectar el gen de la glicoproteína B del virus herpes felino tipo 1, seguido de la determinación del porcentaje de identidad de nucleótidos (PIN) respecto a los datos oficiales del GenBank®. De los 11 gatos estudiados, en solo uno de ellos se pudo amplificar un segmento que correspondía al gen de la glucoproteína B. El PIN resultante (>96 por ciento) confirma que la secuencia obtenida corresponde al gen de la glicoproteína B tipo 1 del virus del herpes felino y se discute la eficiencia del método implementado(AU)

The feline herpesvirus type 1, generates multiple problems and the cat ends with consequences that affect its future quality of life. This virus is distributed throughout the world and is easily transmitted and since it is a latent pathogen, it continues to spread uncontrollably to the entire cat population. The diagnosis is based on clinical signs, today there is only a specific laboratory diagnostic method implemented in Chile to identify the agent, which is not used regularly in the clinic of small animals. Thus, the treatment and diagnosis are usually based on the knowledge and experience of veterinarian without leaving a real confirmation about which agent is causing the symptoms. This research proposed a molecular diagnostic method alternative to timidine kinase detection gene, for which cats under 1 year of age were selected, with symptoms compatible with an infection with the feline herpesvirus. The Polymerase Chain Reaction (PCR) method was used to detect the feline herpesvirus type 1 glycoprotein B gene, followed by the determination of the percentage of nucleotide identity (NIP) from official GenBank® data. Of the 11 cats studied, only one of them resulted in the amplification of a segment corresponding to the glycoprotein B gene. The resulting NIP (> 96 percent) confirms that the sequence obtained corresponds to type 1 glycoprotein B gene of feline herpesvirus and the efficiency of the method implemented is discussed(AU)

Herpes zóster en un niño / Herpes zoster in a child

Se presenta el caso clínico de un niño de 9 años de edad, quien asistió al centro de salud de Santa Lucia, municipio de Itamarandiba, estado brasileño de Minas Gerais, por presentar lesiones inicialmente dolorosas y pruriginosas en el abdomen, que se irradiaban a la espalda unilateralmente. En el examen dermatológico se observaron múltiples vesículas agrupadas en forma de racimo de uvas sobre un fondo eritematoso, localizadas en el lado izquierdo del abdomen y difundidas a la región lumbar, por lo cual se diagnosticó un herpes zóster. Se le indicó el tratamiento oportuno y desaparecieron tanto las lesiones como los síntomas asociados

The case report of a 9 years boy is presented. He attended the health center of Santa Lucía, in Itamarandiba, Brazilian state of Minas Gerais, due to initially painful and pruriginous lesions in the abdomen that irradiated unilaterally to the back. In the dermatologic examination multiple vesicles grouped in a bunch of grapes form on an erythematosus base were observed, located in the left side of the abdomen and diffused to the lumbar region, reason why an herpes zoster was diagnosed. The appropriate treatment was indicated and either the lesions or the associated symptoms disappeared

Herpes zoster de poco frecuente localización en un adolescente inmunocompetente / Herpes zoster of scarcely frequent localization on an immune-compromised adolescent

Se describe el caso de un paciente de 16 años, inmunocompetente, con herpes zoster localizado en la región glútea izquierda, que evolucionó satisfactoriamente. El paciente tiene antecedente de no estar vacunado con la vacuna antivaricela ni haberse contagiado de la varicela, su madre padeció esta enfermedad a las 28 semanas de su embarazo. El herpes zoster aparece cada vez más en la adolescencia e infancia. La localización glútea es una localización poco frecuente(AU)

The case is described of an immunocompetent 16-year-old female patient with herpes zoster located in the left gluteal region, which evolved satisfactorily. The patient has a history of not being vaccinated with the vaccine anicaricela nor infected with chickenpox, her mother suffered from this disease at 28 weeks of pregnancy. Herpes zoster appears more and more in adolescence and childhood. The gluteal location is a rare location(AU)

Zóster com comprometimento do nervo trigêmeo: relato de caso / Zoster with Trigeminal Nerve Damage: Case Report

Zóster é uma doença viral pelo qual o mecanismo de reativação, ainda é pouco compreendido. Entretanto, parece estar relacionado com algum tipo de deficiência na imunidade, além do estresse também ser apontado como fator desencadeante. O diagnóstico, na maioria das vezes, é eminentemente clínico, usualmente determinado por lesões vesículobolhosas que envolvem a pele ao longo do trajeto do nervo branquial. O objetivo desse trabalho é relatar um caso clínico de uma paciente, 21 anos de idade, diagnosticada com zóster e comprometimento do nervo trigêmeo, nos ramos oftálmico, maxilar e mandibular. Verificouse aumento de volume em região de terços médio e inferior da face esquerda, edema palpebral, linfadenopatia em região submandibular, lesões cutâneas vesículo-bolhosas em região periorbital, massetérica, geniana e submandibular. As lesões não ultrapassavam a linha média da face. Após o tratamento a paciente não apresentou sequelas. Salientase a necessidade do conhecimento dessas lesões por parte do cirurgião dentista, a fim de estabelecer diagnóstico e tratamento imediato, para minimizar sintomatologia e acompanhamento da neuralgia pós-zóster... (AU)

Zoster is a viral disease in which the reactivation mechanism is poorly understood. However, it seems to be related to an immunity disability, in addition to stress, which is also be appointed as a triggering factor. The diagnosis, in most cases, is eminently clinical, usually determined by vesicle-bullous lesions involving the skin over the brachial nerve pathway. The aim of this study is to report a case of a 21-year-old patient, diagnosed with zoster, with commitment of the trigeminal nerve comprehending the ophthalmic, maxillary and mandibular branches. There was tissue growth in medium-third region and the lower left cheek, eyelid edema, lymphadenopathy in the submandibular region, vesicle-bullous skin lesions in the periorbital, masseteric, genian and submandibular regions. The injury did not exceed the midline of the face. After treatment the patient had no sequelae. It is emphasized the need of understanding these lesions by the dental surgeon, in order to establish diagnosis and the due immediate treatment in order to reduce the symptoms and the follow up of post-zoster neuralgia... (AU)

Herpes Zóster diseminado / Disseminated herpes zoster

El herpes zóster diseminado es una erupción generalizada de más de 20 vesículas extra-dermatomasque ocurren dentro de la semana del inicio del herpes zóster clásico. Presentamos un paciente inmunocompetente con herpes zóster diseminado, con buena respuesta terapéutica de las lesiones cutáneas tratadas con aciclovir vía oral a una dosis de 4 g/día durante 10 días.El herpes zóster diseminado es una infección potencialmente grave que se puede presentaren ausencia de inmunosupresión.El diagnóstico precoz y el tratamiento oportuno reducen la morbimortalidad y la gravedad de las complicaciones...

Zosteriform cutaneous leishmaniasis due to Leishmania ( Viannia ) panamensis and Leishmania ( Viannia ) braziliensis: Report of three cases / Leishmaniasis cutánea zosteriforme causada por Leishmania ( Viannia) panamensis y Leishmania ( Viannia ) braziliensis: reporte de tres casos

In Colombia, zosteriform leishmaniasis is a little-known and infrequent clinical variant of cutaneous leishmaniasis. Its clinical features include one or more plaques made up of papules and pseudo-vesicles, which conform to a lineal pattern, as well as satellite lesions that affect one or more dermatomes, without crossing the median line. We present three zosteriform cutaneous leishmaniasis cases in which Leishmania panamensis and Leishmania braziliensis were identified as the infective species. In light of the fact that the disease occurs infrequently, diagnosis was reached by taking into account epidemiological and clinical suspicion.

La leishmaniasis zosteriforme es una variante clínica de la leishmaniasis cutánea, infrecuente y poco conocida en Colombia. Clínicamente se caracteriza por una o varias placas conformadas por pápulas y pseudovesículas que siguen un patrón lineal, y por lesiones satelitales que comprometen uno o varios dermatomas sin sobrepasar la línea media. Se presentan tres casos de leishmaniasis cutánea zosteriforme en los que se identificaron Leishmania panamensis y Leishmania braziliensis como especies infectantes. La sospecha epidemiológica derivada de la procedencia de los pacientes, así como la sospecha clínica a partir del reconocimiento de una presentación infrecuente de la enfermedad, permitieron hacer el diagnóstico.

Population-Based Study of the Epidemiology of Herpes Zoster in Korea

General epidemiological data regarding herpes zoster (HZ) are necessary for treatment and prevention of this disease. In addition, epidemiological data can play an important role in evaluating the efficacy and impact of vaccination. Though several epidemiological studies of HZ in Korea have been conducted, they usually depend on hospital-based data and may not be representative of HZ characteristics all over Korea. The purpose of this study was to evaluate the incidence and other epidemiological features of HZ in the general Korean population. We used population-based medical records from the Health Insurance Review & Assessment Service, which includes 50,908,646 medical insurance subscribers, to calculate the incidence of HZ. Also, we analyzed an age-stratified random sample of 1,375,842 individuals to study descriptive epidemiologic characteristics of HZ in Korea in 2011. We observed that the incidence of HZ was 10.4 per 1,000 person-years and was strongly correlated with age. Sex had a major influence on HZ incidence; overall, there were 12.6 cases per 1,000 person years in women and 8.3 cases per 1,000 person years in men. There was no difference in incidence according to the locality and season.

Minimum detection limit of an in-house nested-PCR assay for herpes simplex virus and varicella zoster virus

Introduction Herpes simplex virus (HSV) and varicella zoster virus (VZV) are responsible for a variety of human diseases, including central nervous system diseases. The use of polymerase chain reaction (PCR) techniques on cerebrospinal fluid samples has allowed the detection of viral DNA with high sensitivity and specificity. Methods Serial dilutions of quantified commercial controls of each virus were subjected to an in-house nested-PCR technique. Results The minimum detection limits for HSV and VZV were 5 and 10 copies/µL, respectively. Conclusions The detection limit of nested-PCR for HSV and VZV in this study was similar to the limits found in previous studies. .

Recurrent Infection by varicella-zoster virus with facial scarring / Infecção recorrente pelo vírus varicela-zoster com sequelas cicatriciais na face

Primary contact with the varicella-zoster virus occurs through varicella (chickenpox) and culminates with this virus entering the sensory nerves and remaining latent in the dorsal root ganglion. Transmission occurs by dissemination of infectious particles of the varicella-zoster virus by the aerosol released from nasopharyngeal secretions or skin lesions, or by direct contact with lesions. Herpes zoster occurs after clinically evident reactivation of the virus, affecting the whole distribution of the infected sensory nerve. When compared with primary infection, herpes zoster has a more severe character, requiring the use of pharmaceutical drugs. The cause of reactivation is unknown and may be associated with predisposing factors, such as age, stress or impaired immune system. This study reports a case of a patient who presented clinical manifestations compatible with varicella zoster infection exacerbated by the use of homemade remedies, resulting in a secondary infection and facial scarring.

O contato primário com o vírus varicela-zoster ocorre na varicela (catapora), culminando com a transposição desse vírus para os nervos sensitivos, onde estabelece sua latência no gânglio espinhal dorsal. A transmissão ocorre por disseminação das partículas infecciosas do vírus varicela-zoster através de aerossóis liberados a partir de secreções do nasofaringe ou lesões cutâneas ou, ainda, pelo contato direto com lesões. O herpes-zoster clinicamente evidente ocorre após a reativação do vírus, com o envolvimento da distribuição do nervo sensitivo afetado. Quando comparado com a infecção primária, o herpes-zoster desenvolve um caráter de maior severidade, sendo sempre necessária a administração de uma terapêutica medicamentosa eficaz. A causa dessa reativação é desconhecida, podendo estar relacionada a fatores predisponentes como a faixa etária, estresse ou imunodeficiências. Neste trabalho relata-se um caso clínico em que a paciente apresentou manifestações clínicas condizentes com um quadro característico de infecção por varicela-zoster, complicado por uso de medicação caseira, resultando em infecção secundária e cicatrizes faciais.

Vírus varicela zoster em paralisia de Bell: estudo prospectivo / Varicella zoster virus in Bell's palsy: a prospective study

Although Bell's palsy is the major cause of acute peripheral facial palsy, its pathogenesis remains unknown. Reactivation of the varicella zoster virus has been implicated as one of the main causes of Bell's palsy, however, studies which investigate the varicella zoster virus reactivation in Bell's palsy patients are mostly Japanese and, therefore, personal and geographic characteristics are quite different from our population. AIMS: To determine varicella zoster virus frequency in saliva samples from patients with Bell's palsy, using PCR. MATERIAL AND METHOD: One hundred seventy one patients with acute peripheral facial palsy were prospectively enrolled in this study. One hundred twenty were clinically diagnosed with Bell's palsy, within one week of onset of the disease and no previous anti-viral therapy. We had 20 healthy adults as controls. Three saliva samples were collected from patients and controls at initial examination and at one and two weeks later. The detection of the varicella zoster virus DNA was performed using PCR. RESULTS: Varicella zoster virus was detected in two patients (1.7 percent). The virus was not identified in saliva samples from the controls. CONCLUSIONS: Varicella zoster virus was detected in 1.7 percent of saliva samples from patients with Bell's palsy, using PCR.

Embora a paralisia de Bell seja o tipo mais frequente de paralisia facial periférica,sua causa ainda é objeto de inúmeros questionamentos. A reativação do vírus varicela zoster tem sido considerada uma das principais causas da paralisia de Bell, porém, os poucos trabalhos que estudam a prevalência do VVZ como agente etiológico da PB são japoneses, o que determina características geográficas e populacionais bastante díspares de nossa população. OBJETIVOS: Verificar a frequência do vírus varicela zoster em saliva de indivíduos com PB, pela técnica de PCR. MATERIAL E MÉTODO: Estudo prospectivo com 171 pacientes com PFP, sendo 120 pacientes portadores de paralisia de Bell, com até uma semana de evolução, sem uso prévio de drogas antivirais. O grupo controle foi composto de 20 adultos sadios. Nestes indivíduos foram coletadas três amostras de saliva em semanas consecutivas, para pesquisa de DNA viral pela técnica de PCR. RESULTADOS: O vírus varicela zoster foi encontrado em amostras de saliva de dois pacientes com paralisia de Bell (1,7 por cento). Nenhum vírus foi identificado no grupo controle. CONCLUSÃO: Foi verificada frequência de 1,7 por cento para vírus varicela zoster em amostras de saliva de pacientes com paralisia de Bell, pela técnica de PCR.

Manifestaciones clínicas del herpes zoster en la región maxilofacial / Clinical manifestations of herpes zoster in the maxillofacial region

El Herpes zoster, es una enfermedad viral causada por el virus varicela-zoster, el mismo causante de la varicela. Ocurre a partir de la reactivación del virus latente presente en los ganglios, lo que provoca afecciones en la piel, de mayor o menor gravedad, afectando generalmente individuos inmunocomprometidos. La lesión está caracterizada por presentar vesículas con regiones rojizas que acompañan alguna ramificación nerviosa, que en la mayoria de los casos se presenta de forma unilateral unilateral. El diagnóstico en la mayoría de los casos es extremadamente clínico, pudiendo ser realizados algunos exámenes complementarios. El presente trabajo tiene como objetivo mostrar las manifestaciones clínicas del herpes zoster en la región maxilofacial, así como realizar una revisión de la literatura

O Herpes zoster, é uma doença viral causada pelo vírus varicela-zoster, o mesmo causador da varicela. Ocorre a partir da reativação do vírus latente presente nos gânglios, o que provoca afecções na pele, de maior ou menor gravidade, acometendo geralmente indivíduos imunocomprometidos. A lesão é caracterizada por apresentar vesículas com regiões avermelhadas que acompanham um ramo nervoso, sendo unilateral. O diagnóstico na maioria das vezes é extremamente clínico, podendo ser realizados alguns exames complementares. O presente trabalho tem como objetivo demonstrar as manifestações clinicas do herpes zoster na região maxilofacial, além de realizar uma breve revista da literatura

The Herpes zoster, is a viral disease caused by the varicella-zoster virus, that the same causer of varicella. It occurs from the reactivation of latent virus present in the lymph nodes, what provoke affection in the skin, of greater or lesser severity, generally affecting immunocompromised individuals. The lesion is characterized to present vesicles with red regions that accompany a branch nervous, being unilateral. The diagnosis the most of the time is extremely clinical, and can be made some complementary tests. This work objective to report two cases of herpes zoster in maxillofacial region, and accomplish a brief review of literature