Concurrent Reactivation of VZV and HSV-2 in a Patient with Uncontrolled Diabetes Mellitus: A Case Report

Abstract

Background: Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) and varicella zoster virus (VZV) are neurotropic herpesviruses that cause vesicular mucocutaneous eruptions. They both establish latency in peripheral ganglia and can reactivate to cause episodic outbreaks. HSV occurs more often in the young and may reactivate frequently. VZV reactivation is associated with advancing age due to a decline in the VZV-specific T cell population. While both viruses have been isolated from the same sensory ganglia, they rarely cause simultaneous disease. In most of these cases the viruses have been isolated at different body sites in immunocompromised hosts. However, clinical disease with concurrent detection of both HSV and VZV from the same anatomic location has been described. In a prior study of dual positive specimens, a lower PCR cycle threshold (Ct) was consistently observed for VZV, suggesting that zoster caused subsequent reactivation of HSV.

The management of herpes labialis, oral thrush and angular cheilitis in cases of oral diabetes

“…LATs may impede superinfection by other strains of the same herpes virus or by other herpes viruses. 17,18 This case presents a recurrent infection of herpes labialis coinciding with oral thrush induced by the presence of candida biofilm which may act as a persistent reservoir not only for fungal cells, but also infectious viruses. These viruses might be preserved and protected within the biofilm.…”