An Association of Varicella Zoster Virus, Facial Palsy, and Meningitis in a Young Immunocompetent Male

Ashour, Amr; Obeidat, Khaldun; Azrieh, Bahjat; Alsaud, Arwa; Yassin, Mohamed

doi:10.1159/000506192

Cited by 7 publications

(4 citation statements)

References 10 publications

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“… 17 The diagnosis of these conditions is confirmed by the detection of VZV DNA or anti-VZV IgG or both in CSF samples. 17 , 18 We have detected VZV DNA in meningitis, meningoencephalitis, encephalitis, Ramsay Hunt syndrome, zoster ophthalmicus and hemorrhagic stroke in both primary infection and reactivation. 19…”

Section: The Further Expanded Spectrum Of Vzv Diseases and The Pathwa...mentioning

confidence: 93%

Expanded spectrum of varicella disease and the need for vaccination in India

Srikanth,

Arumugam,

Jeganathan

et al. 2024

Human Vaccines & Immunotherapeutics

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Varicella vaccine was first licensed in Japan and South Korea in 1989 for use in healthy children and was introduced in US in 1995. So far, 29 countries have adopted varicella vaccine in their universal immunization program (UIP). No Asian country, India included, has adopted the varicella vaccine as part of their UIP. The extra-cutaneous sites for VZV diseases are central nervous system and gastrointestinal tract, the expanded disease spectrum includes vasculopathy, myelitis, inflammatory bowel disease, perforated ulcers, and gastritis. The actual disease burden of varicella is not known as most of the infected individuals may not visit the physician. The amplifiable VZV DNA will not always be detectable in cerebrospinal fluid (CSF) samples in protracted illnesses such as vasculopathies, but demonstrable anti-VZV IgG in CSF has diagnostic value. The World Health Organization (WHO) position paper 2014 recommends two doses of varicella and zoster vaccines in targeted population. In India, varicella vaccine is not included in the UIP due to the cost and the belief that lifelong immunity occurs following primary infection. The expanded spectrum of VZV disease and the mounting body of evidence, however, suggest the need for both varicella and zoster vaccines in routine immunization schedule.

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Section: The Further Expanded Spectrum Of Vzv Diseases and The Pathwa...mentioning

confidence: 93%

Expanded spectrum of varicella disease and the need for vaccination in India

Srikanth,

Arumugam,

Jeganathan

et al. 2024

Human Vaccines & Immunotherapeutics

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“…This can be caused by autologous mechanisms of immune activation when immunity decreases due to viral infection or replication due to acute reactivation of latent herpes viruses. 14,15 The risk of stroke may also increase in the post-HZ infection should be considered. 16,17…”

Section: Identification Of Studies Via Databases and Registersmentioning

confidence: 99%

Bell's Palsy as a Potential Predictor Factor for Stroke: A Systematic Literature Review

Indra Febryan Gosal,

Ulfa,

Dewanta Sembiring

2024

sjn

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Introduction: Bell's palsy, which is caused by herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV), can be a marker for stroke. This study aims to identify and explain the potential of Bell's palsy as a predictor factor for stroke. Methods: The literature search process was carried out on various databases (PubMed, Web of Sciences, EMBASE, Cochrane Libraries, and Google Scholar) regarding Bell’s palsy and stroke. The search was performed using the terms: (1) " Bell’s palsy" OR "morbidity" AND (2) "stroke". This study follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) recommendations. Results: There are three studies included in this review. A study by Lee et al. stated that there was a significant value in the group of patients aged over 45 years with low socioeconomic status and patients with a history of hypertension, hyperlipidemia, and coronary artery disease (p < 0.005). A study by Kim et al. stated that the Bell's Palsy group had a hazard ratio (HR) (1.19-2.02) for the development of stroke in the future. Meanwhile, a study by Lee et al. showed a significantly higher cumulative incidence of ischemic stroke in Bell's palsy (P < 0.001) compared with controls, which was different from hemorrhagic stroke (P = 0.141). Conclusion: Bell's palsy acts as a simple predictor of stroke.

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“… 2 These are exceedingly rare complications, with VZV meningoencephalitis or RHS occurring in <1% of OHT recipients 3 , 4 and co-occurring in just a few case reports amongst exclusively non-OHT patients. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

The risks of rejection vs. infection: Ramsay Hunt syndrome, Gradenigo syndrome, and varicella meningoencephalitis in a heart transplant patient

Benavente

Kozai

Silangcruz

et al. 2023

European Heart Journal - Case Reports

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Background Orthotopic heart transplant (OHT) recipients are at increased risk for varicella-zoster reactivation, and severe complications may arise due to their immunosuppressive regimens. Managing immunosuppression in acute infection is difficult, and specific guideline recommendations or evidence from the literature is lacking. However, patient care must involve weighing the risk of transplant rejection with the consequences of worsening infection. Case Summary An OHT patient with history of multiple episodes of acute rejection, latent varicella zoster virus (VZV) infection, and recent completion of anti-viral prophylaxis presented with unilateral facial droop and pain, abducens nerve palsy, crusting facial rash, and ear swelling. Imaging revealed necrotizing otitis externa, with associated otitis media, and petrous apicitis concerning for Gradenigo Syndrome. A VZV-positive viral panel confirmed our suspicion for Ramsay Hunt Syndrome (RHS). The patient's mentation continued to decline, and subsequent lumbar puncture also revealed VZV meningoencephalitis. The patient’s mycophenolate mofetil (MMF) was suspended, with continuation of tacrolimus, and initiation of intravenous acyclovir. The patient demonstrated gradual resolution of his infection, without developing any signs of acute rejection. Discussion VZV reactivation is common in OHT patients, particularly when viral prophylaxis is discontinued, however cardiologists should be aware of the rarer manifestations that can manifest in these immunocompromised patients. This is the first documented case of simultaneous RHS, Gradenigo syndrome and VZV meningoencephalitis in any patient, regardless of transplant status. We demonstrate that even in patient at very high risk of rejection, MMF can be safely discontinued, and host immunity maintained with temporary tacrolimus monotherapy.

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An Association of Varicella Zoster Virus, Facial Palsy, and Meningitis in a Young Immunocompetent Male

Cited by 7 publications

References 10 publications

Expanded spectrum of varicella disease and the need for vaccination in India

Expanded spectrum of varicella disease and the need for vaccination in India

Bell's Palsy as a Potential Predictor Factor for Stroke: A Systematic Literature Review

The risks of rejection vs. infection: Ramsay Hunt syndrome, Gradenigo syndrome, and varicella meningoencephalitis in a heart transplant patient

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