VZV vasculopathy and postherpetic neuralgia: Progress and perspective on antiviral therapy

Department of Neurology, Mail Stop B182, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, CO 8026, USA.
Neurology (Impact Factor: 8.29). 02/2005; 64(1):21-5. DOI: 10.1212/01.WNL.0000148484.19070.4D
Source: PubMed


Two serious complications of varicella-zoster virus (VZV) reactivation are vasculopathy and postherpetic neuralgia (PHN). Clinical-virologic analyses have proven that VZV vasculopathy is caused by chronic active virus infection in cerebral arteries. Conclusive evidence that PHN is caused by persistent or productive VZV infection is less compelling because human ganglia are not accessible during life for pathologic and virologic examination. However, the notion that PHN may reflect a smoldering VZV ganglionitis is supported by 1) the detection of VZV DNA and proteins in peripheral blood mononuclear cells of many patients with PHN; 2) studies of multiple patients with zoster sine herpete, which indicate a productive VZV ganglionitis; and 3) a favorable response of some patients with zoster sine herpete and PHN to antiviral treatment. Few studies have used antiviral therapy to manage PHN with conflicting results. Larger, double-blind studies, which give IV antiviral drug, are needed.

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    • "HZO may lead to severe pain and a wide spectrum of sight-threatening complications affecting all ocular and orbital tissues [3]. These sequela are caused by nerve damage, chronic inflammation, or by direct viral infection [16]. HZO with ocular involvement is relatively common in adults, accounting for 10-25% of all cases of herpes zoster [17]. "
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    ABSTRACT: Here we report a case of optic neuritis in the setting of herpes zoster ophthalmicus (HZO) in a child. A six-year-old girl presented with HZO in the right eye. During the hospitalization, her visual acuity decreased. Fluorescein angiography (FAG) and optical coherence tomography revealed optic neuritis in the affected eye. Visual acuity improved with one month of treatment with acyclovir and steroids. FAG analysis showed no evidence of leakage at the optic disc. At one year post treatment, the patient's fundus exam and vision were normal. Therapy with antivirals and steroids may be effective in patients with childhood HZO optic neuritis.
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    • "More debate persists about the preferred antiviral treatment (valaciclovir or famciclovir versus acyclovir) and the use of steroids (Gilden et al. 2007). Treatment of encephalopathy and cerebral vasculitis requires intravenous acyclovir treatment, as oral treatment may be insufficient (Gilden et al. 2005). Concurrent steroid treatment may have a beneficial role in immunocompetent patients with severe VZV encephalitis (Steiner et al. 2005). "
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