MyMedR

Primary varicella-zoster virus infection in children with haematological malignancy is a life threatening disease. In one year, there were 10 cases of varicella and 2 cases of zoster among these children as well as 5 mothers who were accompanying their children who developed varicella in the oncology ward. Two children died of fulminating disease despite aggressive antiviral and supportive treatment. Acyclovir can be used in treatment and prophylaxis in exposed susceptible children. Varicella -zoster immune globulin is not available in this country. Vaccination with live virus has been shown to be protective in immunocompromised children and needs consideration.

Matched MeSH terms: Herpes Zoster/etiology; Herpes Zoster/epidemiology; Herpes Zoster/therapy*

Congenital varicella syndrome

Lee, Eric K.H., Cheah, Irene G.S.

Malaysian Journal of Child Health, 1997;9(1):97-101.

MyJurnal

Congenital varicella syndrome is a rare outcome of early primary maternal varicella zoster infection. The neuromuscular anomalies, skeletal defects and skin lesions of such a case are described in our case report. The diagnosis of congenital varicella syndrome, the prenatal risk and management of primary maternal varicella infection in pregnancy are also discussed.

Matched MeSH terms: Herpes Zoster

Fulltext Herpes zoster in children with cancer

Menon BS, Wan Maziah WM

Malays J Pathol, 2001 Jun;23(1):47-8.

PMID: 16329548

The aim of this study was to determine the incidence and outcome of herpes zoster hospitalised children with cancer in Kota Baru. It was a retrospective review from January 1994 to December 1998. The diagnosis of herpes zoster was a clinical one. Herpes zoster was diagnosed in 10 of 188 (5%) children with malignancy. The most common malignancy was leukaemia. Nine children were treated with acyclovir. No child developed visceral dissemination and there were no deaths.

Matched MeSH terms: Herpes Zoster/complications*; Herpes Zoster/drug therapy; Herpes Zoster/epidemiology

Fulltext Bilateral optic neuritis in pregnancy

Suraiya MS, Norazlina B, Carmen C, Muhaya M

Med J Malaysia, 2003 Dec;58(5):771-3.

PMID: 15190668

A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.

Matched MeSH terms: Herpes Zoster*

Fulltext A case of Ramsay-Hunt syndrome

Chen WS

Family Physician, 2005;13:22-23.

Study site: Private general practice, Kuala Lumpur, Malaysia

Matched MeSH terms: Herpes Zoster; Herpes Zoster Oticus

Fulltext Chickenpox in pregnancy: still a feared complication

Zainur Rashid, Z., Sharifah Sulaiha, S.A., Darnina, A.J.

International Medical Journal Malaysia, 2007;6(2):1-11.

MyJurnal

Varicella or chickenpox is an infectious disease caused by Varicella Zoster Virus (VZV), which commonly affects the children. It is a mild, self-limiting disease and rarely complicate to serious conditions except in adults. Decreasing incidence of chickenpox among children, probably owing to improved living conditions ,prevention and health care, is worrisome as growing number of adults are being infected. This creates disturbing concerns in many parties as women at childbearing age might get infected and not only are them at a great risk of serious complications, but also their unborn fetus or their newborn babies.

Matched MeSH terms: Herpes Zoster

Public awareness and knowledge of herpes zoster: results of a global survey

Paek E, Johnson R

Gerontology, 2010;56(1):20-31.

PMID: 19776543 DOI: 10.1159/000240046

BACKGROUND: Herpes zoster (HZ), the reactivation of varicella zoster virus, occurs in 1 in 5 people worldwide and may result in a variety of complications, including postherpetic neuralgia (PHN). Treatment of patients with HZ represents a considerable challenge, especially among the elderly who are prone to get a more severe form of the disease and its complications. Since May 2006, a vaccine was approved for the prevention of HZ or PHN among individuals aged 50 or 60 years and older.
OBJECTIVE: Since the success of any new vaccine initiative depends on public awareness of the disease, we conducted the HZ Global Awareness Survey to gauge existing levels of awareness and knowledge of HZ.
METHODS: The survey was conducted by telephone or face-to-face among 8,688 adults >OR=50 years of age in 22 countries between December 2006 and January 2007 and addressed awareness, knowledge, symptoms, and treatment of HZ.
RESULTS: Wide variation in HZ awareness was noted among countries. In some countries (New Zealand, Brazil, and Malaysia) nearly all individuals surveyed (97-100%) over the age of 50 years had heard of HZ. In contrast, less than 20% of individuals surveyed were aware of HZ in Turkey, India and Chile. The survey revealed almost universally poor knowledge of the causes and symptoms of HZ. Only 3% of respondents mentioned chicken pox as the cause of the disease. The majority of respondents were unaware of their risk of HZ, with 71% considering themselves unlikely or very unlikely to develop HZ. The survey also revealed that those respondents with prior HZ experience were much more likely to consider pain as the worst symptom of the disease than those without prior HZ experience. The misconception of HZ-related morbidity among individuals with no first-hand experience of the disease highlights the global educational need to raise awareness of the seriousness of HZ and its potential long-term complications.
CONCLUSIONS: This survey suggests a population-wide effort to improve global awareness of HZ would be required for a successful vaccine initiative. Further studies would be required to understand regional differences in the understanding of HZ.

Matched MeSH terms: Herpes Zoster/prevention & control; Herpes Zoster/psychology*

Fulltext Varicella-zoster infection with secondary bacteremia and extensive facial abscesses

Lee KG, Cheng MO

Med J Malaysia, 2012 Oct;67(5):529.

PMID: 23770874 MyJurnal

Varicella-zoster (chickenpox) infection is a common infectious disease and generally considered to be selflimiting. However, severe bacterial complications associated with the disease have been reported. We describe a case of varicella-zoster infection with secondary Staphylococcus aureus bacteremia, preseptal orbital cellulitis and extensive facial abscesses. She was aggressively treated with intravenous antibiotics and repeated surgical drainage, and eventually made good recovery.

Matched MeSH terms: Herpes Zoster

Fulltext The man with bilateral nipple pain

Hong HC, Koh KC

Malays Fam Physician, 2013;8(3):43-45.

PMID: 25893059 MyJurnal

Figure 1 is a picture of a 48-year-old male patient who presents with progressive painful enlargement of the areolae of 10 months’ duration. There was no bleeding or nipple discharge. He was diagnosed with human immunodeficiency virus (HIV) infection 16 months ago and was initiated on antiretroviral therapy (ARV), which consisted of zidovudine, lamivudine and efavirenz. As his CD4 cell count at diagnosis was less than 200 cells/mm3, he was prescribed trimethoprim-sulphamethoxazole (Bactrim) for prophylaxis against pneumonia due to pneumocystis jirovecii. Physical examination was unremarkable except for bilateral breast enlargement and right-sided old shingles scar in the T4 dermatome distribution.

Matched MeSH terms: Herpes Zoster

Fulltext A cross sectional study of chronic pain relief after bekam (traditional malay "cupping") therapy

Lim KG, Chuah SW, Ee MST, Wong ZG, Murugesan A, Syed Azman SA

International e-Journal of Science, Medicine & Education, 2015;9(2):32-36.

MyJurnal

Introduction: Bekam, an Islamic variant of cupping, is an ancient form of traditional medicine still practised today in Malaysia. There are published findings indicating that cupping benefits patients with low back pain, other musculoskeletal pain and even pain from cancer, herpes zoster and trigeminal neuralgia when pain is measured on an analogue scale. We proposed to investigate whether in addition to pain improvement on an analogue scale we could show if pain relief might be demonstrated in terms of reduction of analgesic use.

Methods: We carried out a retrospective cross sectional study on subjects who had been for outpatient clinic treatment with chronic pain of at least one month and who completed at least two bekam therapy sessions. In addition to documenting a pain score before and after therapy we documented their analgesic consumption.

Results: A total of 77 respondents, with overlapping symptoms of headache, backache and joint pains were included. The mean pain score before bekam therapy was 6.74±1.78, and was 2.66±1.64 after two sessions of therapy. Twenty eight respondents completed six sessions of bekam therapy and had a mean pain score of 2.25±1.32 after. Thirty-four patients consumed analgesic medication before starting bekam therapy and only twelve did so after. The consumption of analgesics was significantly lower after bekam therapy.

Conclusions: Bekam therapy appears to help patients experience less pain and reduce the amount of analgesic medication they consume. Nevertheless only a randomised prospective study will eliminate the biases a retrospective study is encumbered with and we believe would be worth doing.

Matched MeSH terms: Herpes Zoster

Fulltext Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

Chen LK, Arai H, Chen LY, Chou MY, Djauzi S, Dong B, et al.

BMC Infect Dis, 2017 03 15;17(1):213.

PMID: 28298208 DOI: 10.1186/s12879-017-2198-y

BACKGROUND: Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.

METHODS: We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.

RESULTS: From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand. HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years - lifetime risk is approximately one-third. Average incidence of 3-10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients' quality of life and incur heavy healthcare utilisation.

CONCLUSIONS: Several countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.

Matched MeSH terms: Herpes Zoster/epidemiology*; Herpes Zoster/prevention & control; Herpes Zoster Vaccine/immunology; Herpes Zoster Vaccine/therapeutic use*

Herpes zoster of gingiva in an older woman: a rare case report

Chopra A, Sivaraman K, Thomas BS

Gerodontology, 2017 Jun;34(2):280-283.

PMID: 27435832 DOI: 10.1111/ger.12246

OBJECTIVE: The aim of the article is to highlight the distinguishing features of secondary varicella gingival infection in an older women.

BACKGROUND: Herpes zoster is an acute sporadic, painful viral infection in older people caused by the reactivation of the latent varicella zoster virus. Herpes zoster affecting the gingiva without any dermal lesions is a rare pathological condition that mimics many intraoral vesiculobullous lesions. The ambiguous nature of this condition creates a diagnostic dilemma.

MATERIALS AND METHODS: A 58-year-old woman presented with an acute, unilateral and persistent burning sensation and pain in the gingiva with desqaumating vesicullobulous lesion.

RESULTS: The women was diagnosed with secondary varicella zoster infection.

CONCLUSION: Herpes zoster of the gingiva could manifest as painful desquamative vesicular lesions, pulpal or other painful neuralgic condition in older individuals which need careful diagnosis before formulating appropiate treatment plan.

Matched MeSH terms: Herpes Zoster

Fulltext A burning red rash

Chow SY

Am Fam Physician, 2017 Oct 15;96(8):543-544.

PMID: 29094892

Photo quiz: A 43-year-old man presented with a painful rash on the chest and back. The rash started five days earlier on the left side of the chest and then spread to the left side of the back. The pain was burning in nature. He had no history of a similar rash. He had no exposure to chemicals or physical agents. He had diabetes mellitus, hypertension, and dyslipidemia.

On physical examination, the patient was afebrile. Clusters of vesicles with some pustules and crusting (Figures 1 and 2) were noted on the back and chest. The rest of the body was not affected.

Matched MeSH terms: Herpes Zoster*

Fulltext Herpes Zoster Ophthalmicus, persistent hyphema and orbital apex syndrome; a blinding combination

Shavani, Abirami, Adil Hussein, Wan-Hazabbah W.H.

Journal of Biomedical and Clinical Sciences, 2017;2(2):48-51.

MyJurnal

To report a rare case of an elderly gentleman who presented with herpes zoster ophthalmicus, complicated with persistent hyphema and orbital apex syndrome. A 75-year-old Malay gentleman presented with left herpes zoster ophthalmicus that was complicated with complete ophthalmoplegia and ptosis. He developed total hyphema in the affected eye with a secondary elevated intraocular pressure after a week. He was treated with oral acyclovir and topical corticosteroids. However, the total hyphema persisted that required an anterior chamber washout surgery. Herpes Zoster Ophthalmicus complicated with persistent hyphema and orbital apex syndrome is rare and very challenging to manage. Radiological imaging is important to exclude other causes of OAS. It is recommended to treat HZO with systemic acyclovir for a longer duration in view of ocular and neurological involvement.

Matched MeSH terms: Herpes Zoster Ophthalmicus

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