ABSTRACT
BACKGROUND: The varicella zoster virus affects the central or peripheral nervous systems upon reactivation, especially when cell-mediated immunity is impaired. Among varicella zoster virus-related neurological syndromes, meningoradiculitis is an ill-defined condition for which clear management guidelines are still lacking. Zoster paresis is usually considered to be a varicella zoster virus-peripheral nervous system complication and treated with oral antiviral therapy. Yet in the literature, the few reported cases of herpes zoster with mild cerebral spinal fluid inflammation were all considered meningoradiculitis and treated using intravenous antiviral drugs, despite absence of systemic signs of meningitis. Nevertheless, these two clinical pictures are very similar. CASE PRESENTATION: We report the case of an alcohol-dependent elderly Caucasian man presenting with left lower limb zoster paresis and mild cerebral spinal fluid inflammation, with favorable outcome upon IV antiviral treatment. We discuss interpretation of liquor inflammation in the absence of clinical meningitis and implications for the antiviral treatment route. CONCLUSION: From this case report we suggest that varicella zoster virus-associated meningoradiculitis should necessarily include meningitis symptoms with the peripheral neurological deficits and cerebral spinal fluid inflammation, requiring intravenous antiviral treatment. In the absence of (cell-mediated) immunosuppression, isolated zoster paresis does not necessitate spinal tap or intravenous antiviral therapy.
Subject(s)
AIDS Serodiagnosis/methods , HIV Infections/transmission , Infectious Disease Transmission, Patient-to-Professional , Occupational Exposure , Emergency Treatment , Enzyme-Linked Immunosorbent Assay , Female , HIV Infections/diagnosis , HIV Infections/therapy , Humans , Male , Needlestick Injuries , Risk Assessment , Sensitivity and Specificity , Time FactorsABSTRACT
The TNFalpha antagonists have become a standard treatment for many severe chronic inflammatory diseases. After a few years of practical use in individual patient's setting adverse effects, especially infectious have been recorded and a practical attitude can be proposed for prevention and follow-up. TNFalpha antagonists increase the risk of infection by intracellular pathogens. A latent tuberculosis infection must be looked for prior to the initiation of the treatment. A prophylaxis is started in case of positive result. The global infectious risk can also be minimized by an optimal vaccination coverage and a regular screening for leucopenia.
Subject(s)
Infections/etiology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Humans , Risk Factors , Tuberculosis/etiology , Tuberculosis/prevention & controlABSTRACT
The Panton-Valentine leukocidin is associated with staphylococcal skin and pulmonary infections. We describe a school outbreak of skin infections and the public health response to it. Nasal carriage of a Panton-Valentine leukocidin-positive Staphylococcus aureus clone was detected only in previously ill classmates and their family members.
