Varicella-Zoster Virus Reactivation amid the COVID-19 pandemic- Do we need to be vigilant? A mini review

Mishal Shan Siddiqui 1, Nimra Hasnain 1 *
More Detail
1 Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
* Corresponding Author
J CLIN MED KAZ, Volume 6, Issue 60, pp. 40-43. https://doi.org/10.23950/jcmk/9267
OPEN ACCESS 2476 Views 4439 Downloads
Download Full Text (PDF)

ABSTRACT

Reactivation of varicella-zoster infection has been noted in a subset of COVID-19 patients. This has been attributed to immune dysregulation resulting from SARS-CoV-2 infection. Majority individuals presented with shingles, however, neurological complications such as meningoencephalitis and acute retinal necrosis were also reported. Diagnosis in most cases was made on clinical grounds, however, for complications such as meningoencephalitis, the standard investigative measures such as polymerase chain reaction tests (PCR) were conducted. Post-herpetic neuralgia (PHN), a less common sequel of shingles, was witnessed despite the early administration of therapy. Most cases were resolved with antiviral therapy; however, in some instances, corticosteroids had to be administered.
Keywords: herpes zoster, COVID-19, acyclovir, ganciclovir

CITATION

Siddiqui MS, Hasnain N. Varicella-Zoster Virus Reactivation amid the COVID-19 pandemic- Do we need to be vigilant? A mini review. J Clin Med Kaz. 2020;6(60):40-3. https://doi.org/10.23950/jcmk/9267

REFERENCES

  • WHO. Q&A: Influenza and COVID-19-similarities and differences. 2020.
  • Weiss SR, Leibowitz JL. Coronavirus pathogenesis. Advances in virus research. 81: Elsevier; 2011; 85-164. https://doi.org/10.1016/B978-0-12-385885-6.00009-2
  • Drosten C, Günther S, Preiser W, Van Der Werf S, Brodt H-R, Becker S, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. New England journal of medicine. 2003; 348(20):1967-1976. https://doi.org/10.1056/NEJMoa030747
  • Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine. 2020. https://doi.org/10.1056/NEJMoa2001017
  • Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, et al. Clinical features of COVID-19 and factors associated with severe clinical course: a systematic review and meta-analysis. Available at SSRN 3566166. 2020. https://doi.org/10.2139/ssrn.3566166
  • Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. International journal of oral science. 2020; 12(1):1-5. https://doi.org/10.1038/s41368-020-0074-x
  • Recalcati S. Cutaneous manifestations in COVID‐19: a first perspective [published online ahead of print March 26, 2020]. J Eur Acad Dermatol Venereol.10.
  • Wollina U, Karadağ AS, Rowland‐Payne C, Chiriac A, Lotti T. Cutaneous Signs in COVID‐19 Patients: A Review. Dermatologic therapy. 2020.
  • Genovese G, Colonna C, Marzano AV. Varicella‐like exanthem associated with COVID‐19 in an 8‐year‐old girl: A diagnostic clue? Pediatric Dermatology. 2020. https://doi.org/10.1111/pde.14201
  • Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients. Journal of the American Academy of Dermatology. 2020. https://doi.org/10.1016/j.jaad.2020.04.044
  • Mueller NH, Gilden DH, Cohrs RJ, Mahalingam R, Nagel MA. Varicella zoster virus infection: clinical features, molecular pathogenesis of disease, and latency. Neurologic clinics. 2008; 26(3):675-697. https://doi.org/10.1016/j.ncl.2008.03.011
  • Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nature Reviews Immunology. 2020; 1-8. https://doi.org/10.1038/s41577-020-0353-y
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020; 395(10223):497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
  • Wang F, Nie J, Wang H, Zhao Q, Xiong Y, Deng L, et al. Characteristics of peripheral lymphocyte subset alteration in COVID-19 pneumonia. The Journal of infectious diseases. 2020; 221(11):1762-1769. https://doi.org/10.1093/infdis/jiaa150
  • Wei L, Zhao J, Wu W, Zhang Y, Fu X, Chen L, et al. Decreased absolute numbers of CD3+ T cells and CD8+ T cells during aging in herpes zoster patients. Scientific Reports. 2017; 7(1):1-8. https://doi.org/10.1038/s41598-017-15390-w
  • Li H, Liu L, Zhang D, Xu J, Dai H, Tang N, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses. The Lancet. 2020. https://doi.org/10.1016/S0140-6736(20)30920-X
  • Soyuncu S, Berk Y, Eken C, Gulen B, Oktay C. Herpes zoster as a useful clinical marker of underlying cell-mediated immune disorders. Ann Acad Med Singap. 2009; 38(2):136-138.
  • Saati A, Al-Husayni F, Malibari AA, Bogari AA, Alharbi M. Herpes Zoster Co-Infection in an Immunocompetent Patient With COVID-19. Cureus. 2020; 12(7). https://doi.org/10.7759/cureus.8998
  • Elsaie ML, Youssef EA, Nada HA. Herpes zoster might be an indicator for Latent COVID 19 infection. Dermatologic Therapy. 2020:e13666.
  • Pona A, Jiwani RA, Afriyie F, Labbe J, Cook PP, Mao Y. Herpes zoster as a potential complication of coronavirus disease 2019. Dermatologic Therapy. 2020. https://doi.org/10.1111/dth.13930
  • de Freitas Ferreira ACA, Romão TT, SIlva Macedo Y, Pupe C, Nascimento OJ. COVID‐19 and herpes zoster co‐infection presenting with trigeminal neuropathy. European Journal of Neurology. 2020. https://doi.org/10.1111/ene.14361
  • Tartari F, Spadotto A, Zengarini C, Zanoni R, Guglielmo A, Adorno A, et al. Herpes zoster in COVID‐19‐positive patients. International Journal of Dermatology. 2020. https://doi.org/10.1111/ijd.15001
  • Packwood R, Galletta G, Tennyson J. An unusual case report of covid-19 presenting with meningitis symptoms and shingles. Clinical Practice and Cases in Emergency Medicine. 2020; 4(3):316. https://doi.org/10.5811/cpcem.2020.4.47557
  • Elsaie ML, Nada HA. Herpes Zoster (shingles) complicating the course of COVID19 infection. Journal of Dermatological Treatment. 2020 (just-accepted); 1-7. https://doi.org/10.1080/09546634.2020.1782823
  • Shors AR. Herpes zoster and severe acute herpetic neuralgia as a complication of COVID-19 infection. JAAD case reports. 2020; 6(7):656-657. https://doi.org/10.1016/j.jdcr.2020.05.012
  • Ertugrul G, Aktas H. Herpes zoster cases increased during COVID-19 outbreak. Is it possible a relation? Journal of Dermatological Treatment. 2020; 1(1). https://doi.org/10.1080/09546634.2020.1789040
  • Mahalingam R, Wellish M, Brucklier J, Gilden DH. Persistence of varicalla-zoster virus DNA in elderly patients with postherpetic neuralgia. Journal of neurovirology. 1995; 1(1):130-133 https://doi.org/10.3109/13550289509111018
  • Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: results from a population-based survey. The Journal of pain. 2005; 6(6):356-363. https://doi.org/10.1016/j.jpain.2005.01.359
  • Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain. 2016; 157(1):30. https://doi.org/10.1097/j.pain.0000000000000307
  • Cao X. COVID-19: immunopathology and its implications for therapy. Nature reviews immunology. 2020; 20(5):269-270. https://doi.org/10.1038/s41577-020-0308-3
  • Patel P, Undavia A, Choudry R, Zhang Y, Prabhu AM. COVID-19 associated with concomitant Varicella Zoster Viral Encephalitis. Neurology: Clinical Practice. 2020. https://doi.org/10.1212/CPJ.0000000000000902
  • Hassanpour K, Khorasanizadeh F, Ahmadieh H, Nabavi M, Daftarian N, Ramezani A. Varicella Zoster Virus Induced Acute Retinal Necrosis Following Acute Meningoencephalitis in a Patient with Presumed COVID-19. 2020