Jeffrey I. Cohen, MD; Philip A. Brunell, MD; Stephen E. Straus, MD; Philip R. Krause, MD
Cohen JI, Brunell PA, Straus SE, Krause PR. Recent Advances in Varicella-Zoster Virus Infection. Ann Intern Med. 1999;130:922-932. doi: 10.7326/0003-4819-130-11-199906010-00017
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Published: Ann Intern Med. 1999;130(11):922-932.
Varicella-zoster virus has developed a complex strategy that allows it to remain latent in the body and avoid destruction by the immune system. Although varicella and zoster have been recognized since antiquity, several new clinical syndromes—including chronic chickenpox with persistent verrucous lesions and disseminated varicella without skin lesions—have been noted in patients with AIDS. Acyclovir has been the mainstay for treating severe varicella-zoster virus infections; however, newer antiviral agents, including valacyclovir and famciclovir, have expanded therapeutic options for treating adults with herpes zoster. The recently licensed live attenuated vaccine for varicella-zoster virus is effective in preventing chickenpox, and the vaccine's ability to stimulate immunity in seropositive adults suggests a promising strategy with which to modify the course of herpes zoster.
The genome is arranged in unique long ( ), unique short ( ), terminal repeat long ( ), terminal repeat short ( ), and internal repeat ( ) regions. Selected immediate-early ( ), early ( ), late ( ), and latency-associated genes are shown. ssDNA = single-stranded DNA.
A child with varicella who had onset of rash 2 weeks after his sibling ( ) had zoster. The rash is in different stages of evolution, with some vesicles, macules, and papules. The rash is generalized and, in this early stage, mainly on the trunk. The thigh of a child recovering from varicella complicated by necrotizing fasciitis due to group A streptococci. A child with zoster. The rash is unilateral in the distribution of the third and fourth thoracic dermatomes. Verrucous lesions on the foot of an HIV-positive child with progressive varicella who had been treated for several months with antiviral drugs without resolution of the lesions (reproduced with permission from Srugo and colleagues ). A vesicular lesion on the thumb ( ) and papular lesions on the face ( ) of a child who had previously received varicella vaccine. A generalized maculopapular rash in a child who had received varicella vaccine 9 days previously.
Although intracellular drug triphosphate concentrations are more relevant, this schematic provides some explanation for the advantages of intravenous acyclovir (ACV), oral valacyclovir (VCV), and oral famciclovir (FCV) relative to standard high-dose (800 mg) oral acyclovir (ACV). id = per day; IV = intravenous; PO = oral; Q8h = every 8 hours.
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