Jeffrey I. Cohen, MD; Philip A. Brunell, MD; Stephen E. Straus, MD; Philip R. Krause, MD
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.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Cohen JI, Brunell PA, Straus SE, Krause PR. Recent Advances in Varicella-Zoster Virus Infection. Ann Intern Med. ;130:922–932. doi: 10.7326/0003-4819-130-11-199906010-00017
Download citation file:
Published: Ann Intern Med. 1999;130(11):922-932.
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use