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1.
J Korean Med Sci ; 37(20): e165, 2022 May 23.
Article in English | MEDLINE | ID: covidwho-1862587

ABSTRACT

There are several reports that herpes zoster characterized by reactivation of varicella zoster virus (VZV) following coronavirus disease 2019 (COVID-19) vaccines can occur. Herein, we report VZV meningitis, herpes zoster ophthalmicus (HZO), and late neurotrophic keratitis after receiving a second dose of messenger RNA (mRNA) COVID-19 vaccine. A 74-year-old man developed a vesicular skin rash on the forehead, scalp, nose, and left upper eyelid with a severe headache. Five days earlier, he received a second dose of the BNT162b2 mRNA vaccine on his left arm. Ocular examination revealed conjunctival hyperemia and pseudodendrite in the peripheral cornea. VZV was detected in the cerebrospinal fluid using polymerase chain reaction. The patient was diagnosed with HZO and meningitis. The patient was treated with intravenous acyclovir and topical acyclovir ointment and levofloxacin 1.5% eye drops. One month later, he developed a central epithelial defect with a rolled margin, typical of a neurotrophic ulcer. Treatment with a therapeutic contact lens and a combination of topical recombinant human epithelial growth factor and ofloxacin ointment was initiated. At six months after vaccination, the slit-lamp examination findings were stable with a mild corneal superficial stromal haze.


Subject(s)
COVID-19 , Herpes Zoster Ophthalmicus , Meningitis , Acyclovir/therapeutic use , Aged , Antiviral Agents/therapeutic use , COVID-19/prevention & control , Herpes Zoster Ophthalmicus/chemically induced , Herpes Zoster Ophthalmicus/diagnosis , Herpes Zoster Ophthalmicus/drug therapy , Herpesvirus 3, Human/genetics , Humans , Male , Meningitis/chemically induced , Ointments/therapeutic use , Vaccination/adverse effects , Vaccines, Synthetic/adverse effects
2.
Int J Infect Dis ; 119: 184-186, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1838872

ABSTRACT

We present, to our knowledge, the second case report of a 46-year old female who developed varicella-zoster virus (VZV) meningitis after BNT162b2 mRNA COVID-19 vaccination. The patient is immunocompetent and has no known predisposing risk factors for developing VZV meningitis. The patient received acyclovir therapy and subsequently had a complete recovery. We describe possible mechanisms of VZV meningitis after mRNA COVID-19 vaccination.


Subject(s)
COVID-19 , Herpes Zoster , Meningitis , Adult , COVID-19/diagnosis , COVID-19 Vaccines/adverse effects , Female , Herpes Zoster/diagnosis , Herpes Zoster/drug therapy , Herpes Zoster/etiology , Herpesvirus 3, Human/genetics , Humans , Meningitis/complications , Middle Aged , RNA, Messenger , Vaccination/adverse effects
3.
Cornea ; 41(5): 649-650, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1778965

ABSTRACT

PURPOSE: The purpose of this study was to report a case of acute exacerbation in varicella-zoster virus (VZV) keratitis after SARS-CoV-2 vaccination. METHODS: An 87-year-old man, with a history of herpes zoster ophthalmicus 10 years ago, was referred for sudden visual impairment in his left eye that started 2 days after his second dose of SARS-CoV-2 mRNA vaccine BNT162b2. RESULTS: At presentation, his visual acuity was hand motion. Slitlamp examination revealed diffuse corneal stromal edema and nasal stromal infiltration. After treatment for 2 weeks with oral valacyclovir and topical corticosteroids, the problematic lesion was recovered and his visual acuity was restored to 20/30. CONCLUSIONS: We believe that this is the first report of possible association between recurrence of VZV keratitis and SARS-CoV-2 vaccination. We believe that T-cell activation by the host response after vaccination may affect the recurrence of VZV keratitis. Physicians should be aware of the potential of recurrence of VZV keratitis associated with the SARS-CoV-2 messenger RNA vaccine.


Subject(s)
COVID-19 , Herpes Zoster Ophthalmicus , Keratitis , Aged, 80 and over , COVID-19 Vaccines/adverse effects , Herpes Zoster Ophthalmicus/complications , Herpes Zoster Ophthalmicus/diagnosis , Herpes Zoster Ophthalmicus/drug therapy , Herpesvirus 3, Human/genetics , Humans , Keratitis/diagnosis , Male , SARS-CoV-2 , Vaccination , Vaccines, Synthetic
4.
Front Public Health ; 9: 738412, 2021.
Article in English | MEDLINE | ID: covidwho-1775888

ABSTRACT

BACKGROUND: Unbiased metagenomic next-generation sequencing (mNGS) detects pathogens in a target-independent manner. It is not well-understood whether mNGS has comparable sensitivity to target-dependent nucleic acid test for pathogen identification. METHODS: This study included 31 patients with chickenpox and neurological symptoms for screening of possible varicella-zoster virus (VZV) central nervous system (CNS) infection. Microbiological diagnosing of VZV cerebrospinal fluid (CSF) infection was performed on stored CSF samples using mNGS, quantitative and qualitative VZV-specific PCR assays, and VZV IgM antibodies test. RESULTS: The median age was 30.0 [interquartile range (IQR), 24.3-33.3] years. 51.6% of the patients were men. About 80.6% of the patients had normal CSF white blood cell counts (≤ 5 × 106/L). VZV IgM antibodies presented in 16.1% of the CSF samples, and nucleic acids were detectable in 16.1 and 9.7% using two different VZV-specific real-time PCR protocols. Intriguingly, maximal identification of VZV elements was achieved by CSF mNGS (p = 0.001 and p = 007; compared with qualitative PCR and VZV IgM antibody test, respectively), with sequence reads of VZV being reported in 51.6% (16/31) of the CSF samples. All VZV PCR positive samples were positive when analyzed by mNGS. Of note, human betaherpesvirus 6A with clinical significance was unexpectedly detected in one CSF sample. CONCLUSIONS: Our study suggests that CSF mNGS may have higher sensitivity for VZV detection than CSF VZV PCR and antibody tests, and has the advantage of identifying unexpected pathogens.


Subject(s)
Central Nervous System Infections , Chickenpox , Adult , Central Nervous System , Herpesvirus 3, Human/genetics , High-Throughput Nucleotide Sequencing/methods , Humans , Male
5.
Int J Infect Dis ; 113: 55-57, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1442402

ABSTRACT

We report a case of varicella zoster virus (VZV) meningitis following BNT162b2 mRNA COVID-19 vaccination in an immunocompetent patient. A final diagnosis was made based on identification of VZV via positive polymerase chain reaction of cerebrospinal fluid along with characteristic symptoms such as fever, headache, and stiff neck. This phenomenon has been reported elsewhere; this is the 13th such case reported worldwide and the 7th case in immunocompetent patients, indicating the need for careful monitoring after COVID-19 vaccines.


Subject(s)
COVID-19 , Herpes Zoster , COVID-19 Vaccines , Herpes Zoster/diagnosis , Herpesvirus 3, Human/genetics , Humans , RNA, Messenger , SARS-CoV-2 , Vaccination
6.
Infect Dis (Lond) ; 53(9): 713-718, 2021 09.
Article in English | MEDLINE | ID: covidwho-1172620

ABSTRACT

BACKGROUND: Varicella-zoster virus (VZV) infects and establishes latency in neurons in the ganglia of the cranial nerve, dorsal root and enteric ganglia. VZV reactivation in enteric neurons (enteric zoster) can cause non-specific abdominal pain and/or serious gastrointestinal dysfunction without cutaneous manifestations. Detection of VZV DNA in saliva may be useful for identifying enteric zoster. We evaluated the frequency of putative enteric zoster based on the presence of salivary VZV DNA in patients with acute abdominal pain. METHODS: Adult patients who visited the emergency room due to moderate to severe acute abdominal pain were prospectively enrolled at a tertiary hospital between May 2019 and November 2019. Abdominopelvic computed tomography (APCT) was performed in all patients. We also evaluated the presence of salivary VZV DNA in patients with confirmed coronavirus disease-19 (COVID-19) who were under stressful conditions. Saliva samples were collected from all studied patients. Enteric zoster was suspected based on the presence of salivary VZV DNA, detected using real-time polymerase chain reaction (PCR). RESULTS: Fifty patients with moderate to severe abdominal pain were enrolled. Five of 50 patients exhibited positive VZV-DNA PCR results. APCT revealed that among these five patients, two had pancreatic head cancer, two had small bowel obstruction after intra-abdominal surgery, and one had no remarkable findings. However, all 14 patients with COVID-19 showed negative salivary VZV-DNA PCR results. CONCLUSIONS: Approximately 10% of patients with moderate to severe acute abdominal pain showed positivity for salivary VZV DNA. Further studies are warranted on whether antiviral therapy based on salivary VZV-DNA PCR results may relieve abdominal pain in the studied patient population. TRIAL REGISTRATION: clinicaltrial.gov, number NCT03862092.


Subject(s)
COVID-19 , Herpes Zoster , Abdominal Pain , Adult , DNA, Viral/genetics , Herpes Zoster/diagnosis , Herpesvirus 3, Human/genetics , Humans , Prospective Studies , SARS-CoV-2 , Saliva
7.
Comput Methods Programs Biomed ; 196: 105707, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-720119

ABSTRACT

BACKGROUND AND OBJECTIVE: One of the main goals of epidemiological studies is to build models capable of forecasting the prevalence of a contagious disease, in order to propose public health policies for combating its propagation. Here, the aim is to evaluate the influence of immune individuals in the processes of contagion and recovery from varicella. This influence is usually neglected. METHODS: An epidemic model based on probabilistic cellular automaton is introduced. By using a genetic algorithm, the values of three parameters of this model are determined from data of prevalence of varicella in Belgium and Italy, in a pre-vaccination period. RESULTS: This methodology can predict the varicella prevalence (with average relative error of 2%-4%) in these two European countries. Belgium data can be explained by ignoring the role of immune individuals in the infection propagation; however, Italy data can be explained by considering contagion exclusively mediated by immune individuals. CONCLUSIONS: The role of immune individuals should be accurately delineated in investigations on the dynamics of disease propagation. In addition, the proposed methodology can be adapted for evaluating, for instance, the role of asymptomatic carriers in the novel coronavirus spread.


Subject(s)
Adaptive Immunity/immunology , Varicella Zoster Virus Infection/epidemiology , Algorithms , Belgium/epidemiology , Herpesvirus 3, Human/genetics , Humans , Italy/epidemiology , Models, Theoretical , Mutation , Prevalence , Probability , Reproducibility of Results , Software , Varicella Zoster Virus Infection/transmission
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