Parechovirus-A3 encephalitis presenting with focal seizure mimicking herpes simplex virus infection

BackgroundFebrile neonates and young infants presenting with seizure require immediate evaluation and treatment. Herein we experienced two young infants with parechovirus-A3 (PeV-A3) encephalitis, initially presented with focal seizure suspecting herpes simplex virus (HSV) encephalitis.CasesWe have experienced 2 infantile cases, initially presented with focal seizure. At presentation, HSV encephalitis was strongly suspected and empiric acyclovir therapy was started; however, serum and/or cerebrospinal fluid (CSF) PCR for HSV were negative. Instead, serum and/or CSF PCR for parechovirus-A was positive. PeV-A3 infection was confirmed by genetic sequence analyses. Both cases required multiple anticonvulsant therapy and intensive care for intractable seizure. Diffusion-weighted imaging of brain magnetic resonance imaging (MRI) showed distinct findings; high-intensity lesions in the gray matter of parietal and occipital lobes in Case 1, and bilateral decreased diffusion of the deep white matter and corpus callosum in Case 2. We have followed two cases more than four years; Case 1 developed epilepsy, has been on an anticonvulsant to control her seizure. Case 2 has significant neurodevelopmental delay, unable to stand or communicate with language.ConclusionsPeV-A3 encephalitis needs to be in differential diagnosis when neonates and young infants present with focal seizure, mimicking HSV encephalitis. Special attention may be necessary in patients with PeV-A3 encephalitis given it could present with intractable seizure with high morbidity in a long-term.     

Herpes simplex virus infection: Management of primary oral lesions in children

Primary herpetic gingivostomatitis (PHGS) represents the most observed clinical feature of primary herpes infection with the simplex virus (HSV). It is often caused by HSV‐1 and affects children most of the time. Unlike, the majority of primary HSV infections that is asymptomatic. It may be preceded by some prodromal symptoms like fever, anorexia, irritability, malaise, and headache. After the resolution of the primary infection, the virus remains latent in a nervous ganglion. The aim of the present paper was to report a case of severe PHGS with herpetic whitlow in a 10‐year‐old child.     

巨细胞病毒感染合并播散性单纯疱疹病毒感染一例

巨细胞病毒（CMV）合并播散性单纯疱疹病毒（HSV）感染往往发生于HIV感染的患者,HIV阴性患者少见。该文报道1例肾病患者给予糖皮质激素治疗导致CMV和HSV重新激活,给予伐昔洛韦、更昔洛韦、亚胺培南、利奈唑胺等抗感染治疗后CMV-DNA复制数降至正常,皮疹有好转,但50 d后因并发重症免疫抑制宿主肺炎、Ⅰ型呼吸衰竭死亡。该例提示CMV合并播散性HSV感染预后差,应引起临床重视。     

1202例疑似生殖器疱疹患者HSV基因检测结果分析

目的了解广州新塘地区疑似生殖器疱疹患者单纯疱疹病毒（HSV）感染情况。方法用PCR．荧光探针法（FQ．PCR）对我院门诊1202例疑似生殖器疱疹患者进行HSV-I／II基因检测。结果在1202例生殖器疱疹疑似患者中,检测出HSV-I型阳性患者8例,阳性率为0．67％（8／1202）;HSV-II型阳性患者282例,阳性率为23．46％（282／1202）,总计单纯疱疹病毒阳性患者290例,阳性率24．13％（290／1202）。HSV-I型感染率与HSV-II型感染率比较,差异具有统计学意义（P〈0．01）。290例单纯疱疹病毒感染患者中男性患者193例,阳性率24．62％（193／748）,女性患者97例,阳性率23．21％（97／418）,男性与女性的感染率比较,差异不具有统计学意义（P〉0．05）。结论①广州新塘地区疑似生殖器疱疹患者HSV检出率较高近1／4,感染率有型别差异,以HSV-II型为主,提示临床需重视对疑似生殖器疱疹病毒患者进行HSV检测,避免误诊漏诊。②HSV感染率无性别差异。③FQ．PCR在HSV检测中具有简便、灵敏度高、快捷等特点,具有良好的推广、应用前景。     

Recurrent herpes zoster in a rheumatoid arthritis patient treated with tofacitinib: A case report and review of the literature

BACKGROUNDTofacitinib is an oral Janus kinase (JAK) inhibitor that is currently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis (RA). Varicella zoster virus reactivation leading to herpes zoster (HZ) is an adverse effect of this drug; however, recurrent HZ at the same site is a rare clinical condition.CASE SUMMARYA 70-year-old female RA patient had undergone 1-year of tofacitinib treatment (10 mg daily). About 1 mo after initiation of oral tofacitinib, she developed blisters on the left flank and abdomen and was diagnosed with HZ; antiviral therapy with acyclovir was resolutory. However, 5 d prior to presentation at our hospital, erythema and blisters with severe pain recurred at the same site. Small clustered blisters and bullous were visible on the left lumbar abdomen and perineum, with a pain score of 8 (visual analogue scale). Antiviral, nutritional supplement, analgesic and other treatments led to healing but over an atypically long period (approximately 26 d, vs approximately 1 wk). HZ is a common and serious adverse reaction of JAK inhibitors, but it rarely recurs. Our patient’s experience of HZ recurrence at the same site, with a wider affected area, more severe pain and longer healing period, is inconsistent with previous reports.CONCLUSIONSame-anatomical site HZ recurrence may occur during oral tofacitinib treatment, with more severe clinical manifestations than in the initial occurrence.     

Development and clinical evaluation of a novel fully automated qualitative PCR assay for the diagnosis of anogenital herpes simplex virus infection

Molecular detection of viral infections has the potential to improve microbial diagnostics, particularly with the emergence of rapid automated systems. We describe the design of the IDbox fully automated cassette-based system for nucleic acid extraction and real-time PCR amplification and perform a clinical evaluation for the diagnosis of genital herpes simplex infections. At optimal cutoff values determined by receiver-operator curves, the IDbox showed sensitivities of 94.9% (95% confidence interval [CI] 84.9–98.7%) and 97.0% (95% CI 88.5–99.5%) and specificities of 96.7% (95% CI 91.2–98.9%) and 97.3% (95% CI 91.9–99.3%) relative to herpes simplex virus culture and PCR, respectively. We discuss relevant design characteristics and approaches used for each step of the analytical process to enhance assay sensitivity and provide accurate results in the presence of potential cross-reactive organisms and interfering substances.     

Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study: A case report

BACKGROUNDHerpes zoster is a painful infectious disease caused by the varicella zoster virus. Herpes zoster radiculopathy, which is a type of segmental zoster paresis, can complicate the disease and cause motor weakness. This complication should be considered when a patient with a rash complains of acute-onset motor weakness, and the diagnosis can be verified via electrodiagnostic study. CASE SUMMARYA 64-year-old female with a history of asthma presented to the emergency department with stabbing pain, an itching sensation, and a rash on the right anterior shoulder that had begun 5 d prior. Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions. Because herpes zoster was suspected, the patient immediately received intravenous acyclovir. On the third hospital day, she complained of motor weakness in the right upper extremity. Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression. On the 12^th hospital day, electrodiagnostic study revealed right cervical radiculopathy, mainly in the C5/6 roots. Six months later, monoparesis resolved, and follow-up electrodiagnostic study was normal. CONCLUSIONThis case emphasizes that clinicians should consider the possibility of post-herpetic paresis, such as herpes zoster radiculopathy, and that electrodiagnostic study is useful for diagnosis and follow-up.     

单纯疱疹病毒感染与冠心病急性心肌梗死血液流变特性的相关性研究

目的　探讨单纯疱疹病毒 (HSV)感染与冠心病心肌梗死的关系。方法　测定 5 1例急性心肌梗死 (AMI)和 4 2例陈旧性心肌梗死 (OMI)患者及 31例冠脉造影正常者 (NC)的HSV - 1特异性抗体 (HSV - 1IgG、HSV - 1IgM)浓度 ,并同步观察纤维蛋白原 (Fg)、血液流变特性指标变化及其与HSV - 1感染的相关性。结果　AMI组HSV - 1IgG阳性率及平均浓度明显高于NC组 (P <0 0 5 ) ,HSV - 1DNA检测结果与之吻合。校正冠心病危险因素前后HSV - 1IgG阳性与AMI均有相关关系 (OR4 2 6 6 ,P =0 0 19;OR 3 82 1,P =0 0 32 )。AMI组IgG、Fg、血浆黏度、低 /高切全血黏度、红细胞压积、红细胞聚集指数高于 ,而红细胞变形指数低于NC组及OMI组 (P均 <0 0 5 )。AMI组中HSV - 1( )组上述指标 (除HCT外 )的改变与同组中HSV - 1( - )组及与NC、OMI组中HSV - 1( )组比较有显著性差异 (P均 <0 0 5 ) ,AMI组中HSV - 1( )组IgG与Fg、血浆黏度、低 /高切全血黏度、红细胞聚集指数呈正相关 ,而与红细胞变形指数呈负相关 ,调整冠心病的危险因素前后IgG与Fg均呈正相关。结论　HSV - 1感染与CHD(AMI)之间存在明显的相关性 ,与Fg、血液流变特性指标也存在相关性。     

Fulminant gestational hepatitis due to primary herpes simplex type 2 infection: use of serum HSV polymerase chain reaction for noninvasive diagnosis

Acute gestational hepatitis from herpes simplex virus (HSV) infection is a rare but potentially life-threatening condition. We present the first reported case of primary HSV type 2 hepatitis in a pregnant woman who was diagnosed by detection of HSV-2 viremia via real-time polymerase chain reaction. The patient was successfully treated with acyclovir and delivered a healthy infant.     

Improvement of refractory acyclovir-resistant herpes simplex virus type 1 infection by continuous acyclovir administration

Resistant herpes simplex virus type 1 (HSV-1) infection is sometimes fatal for immunocompromised patients. Here, we report 10-year-old girl receiving hematopoietic stem cell transplantation developed refractory HSV-1 infection, which was persisted to intermittent acyclovir (ACV) or foscarnet (FOS) administrations but was improved by continuous ACV administration. The isolates from the lesion were identified with low susceptibilities to ACV and FOS by plaque reduction assay due to DNA pol gene mutation. Continuous ACV administration overcomes the efficacy of intermittent administration and could be the best option to treat severe HSV-1 infectious patients.     

Transverse myelitis after infection with varicella zoster virus in patient with normal immunity: A case report

BACKGROUNDVaricella zoster virus (VZV) is a human neurotropic and double-stranded DNA alpha-herpes virus. Primary infection with VZV usually occurs during childhood, manifesting as chickenpox. Reactivation of latent VZV can lead to various neurological complications, including transverse myelitis (TM); although cases of the latter are very rare, particularly in newly active VZV infection.CASE SUMMARYWe report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection. The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period. Cerebrospinal fluid testing was denied, but findings from magnetic resonance imaging and collective symptomology indicated TM. He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned, necessitating multiple hospital admissions. After about a month of repeated treatments, he was deemed sufficiently improved for hospital discharge to home.CONCLUSIONVZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.     

Chronic active Epstein-Barr virus infection treated with PEG-aspargase: A case report

BACKGROUNDChronic active Epstein-Barr virus infection (EBV) is a systemic EBV-positive lymphoproliferative disease, which may lead to fatal illness. There is currently no standard treatment regimen for chronic active EBV (CAEBV), and hematopoietic stem cell transplantation is the only effective treatment. We here report a CAEBV patient treated with PEG-aspargase, who achieved negative EBV-DNA.CASE SUMMARYA 33-year-old female Chinese patient who had fever for approximately 3 mo was admitted to our hospital in December 2017. EBV-DNA was positive with a high copy number. She was diagnosed with chronic active EB virus infection. PEG-aspargase was administered at a dose of 1500 U/m² at a 14-d interval, resulting in eradication of EBV for more than 6 mo. The effect of PEG-aspargase in this patient was excellent.CONCLUSIONA chemotherapy regimen containing PEG-aspargase for CAEBV may be further considered.     

Resolution of herpes zoster-induced small bowel pseudo-obstruction by epidural nerve block: A case report

BACKGROUNDWhen herpes zoster is complicated with paralytic ileus, this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon; small intestinal obstruction is rare. Here, we present a patient with a very rare case of small bowel pseudo-obstruction.CASE SUMMARYA 76-year-old female patient complained of right upper quadrant pain. Two days later, a blistering, right-sided rash of the thoracoabdominal dermatome (T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate. Computed tomography of the abdomen confirmed small bowel pseudo-obstruction. Antiviral therapy, gastrointestinal decompression, and enemas proved unproductive. After 4 d of stagnation, an epidural block was performed for pain relief and prompted the passage of gas and stool, resolving the obstructive problem. Three days later, the rash appeared dry and crusted, and the pain diminished. After 5 d, no abnormality was visible by gastroenteroscopy, and the patient was discharged on day 7.CONCLUSIONThis case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction. Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.     

Oral myiasis after cerebral infarction in an elderly male patient from southern China: A case report

BACKGROUNDMyiasis is a rare but risky pathology caused by a parasitic infestation of humans and animals by the dipterous larva. Oral myiasis occurs when soft tissues of the oral cavity are invaded by the larvae of flies. It is not a common disease for the reason that the oral cavity is not easily reachable for the fly to lay eggs. But it can cause pain, infection, uncomfortable feeling when the worms move, tissue destruction and/or even life-threatening hemorrhages.CASE SUMMARYWe reported a case of oral myiasis after cerebral infarction in a 78-year-old male patient from southern China (Guangdong Zhanjiang). As a result of cerebral infarction, he suffered from right hemiplegia, mobility and mental decline for about 3 mo. He had difficulty swallowing and was fed via a feeding tube. He mostly engaged in mouth breathing and had poor oral and dental hygiene. More than 20 live larvae were collected from the patient’s oral cavity, which were localized in the maxillary gingiva, the mandibular gingiva and the tongue. The patient recovered after the routine oral cleaning, removal of maggots, debridement and anti-infection treatment.CONCLUSIONEarly diagnosis and treatment of this infestation are essential due to the bothersome symptoms, such as inflammation, intense anxiety over the larvae movement, possible serious complications, etc. Clinical staff should be familiar with this infestation, and this disease should be considered, especially in physically and mentally disabled patients or those at significant risk for infection. Necessary measures, including good sanitation, personal and environmental hygiene and special care should be adopted so as to prevent this disease.     

Benign lymphoepithelial cyst of parotid gland without human immunodeficiency virus infection: A case report

BACKGROUNDBenign lymphoepithelial cyst (BLEC) of the parotid gland is a rare benign embryonic-dysplastic cystic tumor in the anterolateral neck that occurs most commonly in human immunodeficiency virus (HIV)-positive adults and rarely in non-acquired immune deficiency syndrome patients. The main presentation is a slow-growing, painless mass, and secondary infection may cause acute inflammatory symptoms.CASE SUMMARYA 44-year-old Chinese male patient presented with a 1-year history of a mass in the left side of the neck. On physical examination, a mass similar in size and shape to a quail egg was found in the left parotid gland. The mass was tough, without tenderness, and easily moveable. The results of HIV tests, including antibody and nucleic acid tests and CD4+ T cell examination, were negative. Imaging examination revealed a left parotid gland mass. The patient underwent surgical treatment, and BLEC was diagnosed based on postoperative pathology. After 2 years of follow-up, the patient survived well without related discomfort.CONCLUSIONThe detailed characteristics of a BLEC in a patient without HIV infection contribute to an improved understanding of this rare disease.     

Oral granuloma in a pediatric patient with chronic graft-versus-host disease: A case report

BACKGROUNDOral mucositis is often observed with graft-versus-host disease (GVHD); however, the occurrence of oral granuloma is rare. The rapid increase in granulomatous lesions should be distinguished from malignant tumors in patients with GVHD because malignant diseases can develop in those patients. This case is the youngest pediatric patient with granuloma associated with GVHD.CASE SUMMARYThe patient was a 1-year and 5-mo-old girl who presented to our department for the management of oral nodules. At the age of 5 mo, she was diagnosed with primary immunodeficiency disease, cord blood transplant was performed at 11 mo and bone marrow transplant at 1 year of age. After transplantation, GVHD and oral mucositis developed, and tacrolimus was administered. Interestingly, nodules appeared on the lower lip and buccal mucosa, which spontaneously disappeared. Then, a new nodule appeared on the left lateral border of the tongue. Resection was performed and the histopathological diagnosis was granuloma. The origin of these nodules were considered to be the fibroblasts activated under inflammation caused by GVHD because the calcineurin inhibitor tacrolimus acted on their proliferation.CONCLUSIONIt is very important to distinguish oral granulomatous lesions from malignancies if GVHD is present at the base and if immunosuppressive agents and steroids are being administered.