Facial paralysis due to Ramsay Hunt syndrome - A rare condition.

Ramsay Hunt syndrome (or herpes zoster oticus) is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion occurs. Usually, there are auricular vesicles and symptoms and signs such otalgia and peripheral facial paralysis. In addition, rarely, a rash around the mouth can be seen. Immunodeficient patients are more susceptible to this condition. Diagnosis is essentially based on symptoms. We report the case of a diabetic female patient who sought the emergency department with a complaint of this rare entity.

Facial paralysis due to Ramsay Hunt syndrome - A rare condition / Paralisia facial secundária à síndrome de Ramsay Hunt - Uma condição rara

Summary Ramsay Hunt syndrome (or herpes zoster oticus) is a rare complication of herpes zoster in which reactivation of latent varicella zoster virus infection in the geniculate ganglion occurs. Usually, there are auricular vesicles and symptoms and signs such otalgia and peripheral facial paralysis. In addition, rarely, a rash around the mouth can be seen. Immunodeficient patients are more susceptible to this condition. Diagnosis is essentially based on symptoms. We report the case of a diabetic female patient who sought the emergency department with a complaint of this rare entity.

Resumo A síndrome de Ramsay Hunt (ou zóster auricular) é uma complicação rara do herpes-zóster em que ocorre reativação de uma infecção latente pelo vírus varicela-zóster no gânglio geniculado. Geralmente, estão presentes vesículas auriculares e sintomas como otalgia e paralisia facial periférica. Além disso, mais raramente pode haver rash ao redor da boca. Pacientes com imunodeficiência apresentam maior susceptibilidade para essa condição. O diagnóstico é essencialmente pelo quadro clínico. É apresentado o caso de uma paciente diabética que compareceu ao setor de emergência com essa manifestação rara.

Acupuncture: a potential modality for the treatment of auricular pruritus in Ramsay Hunt Syndrome with multiple cranial nerve lesions.

Auricular pruritus coexisted with multiple cranial nerve lesions in Ramsay Hunt syndrome has been rarely reported in the literature especially its treatment. However, auricular pruritus cannot be better improved along with the improvement of multiple cranial nerve lesions. We tried to solve the problem with acupuncture and got experience from it. The following 2 cases of Ramsay Hunt syndrome show a potential modality for the treatment of auricular pruritus with acupuncture.

Phylogenetic and structural studies of a novel equine papillomavirus identified from aural plaques.

Papillomaviruses (PVs) infect a wide range of animal species and show great genetic diversity. To date, excluding equine sarcoids, only three species of PVs were identified associated with lesions in horses: Equus caballus papillomavirus 1 (EcPV1-cutaneous), EcPV2 (genital) and EcPV3 (aural plaques). In this study, we identified a novel equine PV from aural plaques, which we designated EcPV4. Cutaneous samples from horses with lesions that were microscopically diagnosed as aural plaques were subjected to DNA extraction, amplification and sequencing. Rolling circle amplification and inverse PCR with specific primers confirmed the presence of an approximately 8 kb circular genome. The full-length EcPV4 L1 major capsid protein sequence has 1488 nucleotides (495 amino acids). EcPV4 had a sequence identity of only 53.3%, 60.2% and 51.7% when compared with the published sequences for EcPV1, EcPV2 and EcPV3, respectively. A Bayesian phylogenetic analysis indicated that EcPV4 clusters with EcPV2, but not with EcPV1 and EcPV3. Using the current PV classification system that is based on the nucleotide sequence of L1, we could not define the genus of the newly identified virus. Therefore, a structural analysis of the L1 protein was carried out to aid in this classification because EcPV4 cause lesion similar to the lesion caused by EcPV3. A comparison of the superficial loops demonstrated a distinct amino acid conservation pattern between EcPV4/EcPV2 and EcPV4/EcPV3. These results demonstrate the presence of a new equine PV species and that structural studies could be useful in the classification of PVs.

[Retrospective evaluation of data over five years of the BVDV prevention program using ear notch samples from the autonomous province of Bolzano (Italy)]. / Retrospektive Auswertung von Daten über fünf Jahre BVDV-bekämpfungsprogramm mittels Ohrgewebeproben in der Autonomen Provinz Bozen (Italien).

In 2005 the Autonomous Province of Bolzano implemented a BVD-Virus control programme by testing all newborn calves for Bovine Viral Diarrhoea Virus (BVDV) antigen by analysing ear notch samples. In eradication programs between November 2005 and October 2010 a total of 344,108 newborn calves were ear notch sampled and analysed for BVDV by an antigen ELISA detecting the E(rns) (HerdCheck BVDV Antigen/Serum Plus, Idexx Laboratories, Switzerland). The tissue samples were collected during calf ear tagging (within the first 20 days of life) using two sampling devices (TypiFix-System, Agrobiogen GmbH [Germany] and Allflex [France]). 0.4% (1400) of the collected samples showed a positive result, and of these, 583 calves were subjected to a follow-up examination, analysing the samples again by ELISA as well blood samples by Reverse transcriptase-PCR. Blood samples were also collected from the dam, if still present on the farm by the time of sampling. These results suggest that a BVDV control programme testing all newborn calves sampled for BVDV antigen by analysing an ear notch sample in principle is practicable. However, due to the low positive predictive value (75%) of the E(rns)-ELISA used, not all persistently infected calves can be detected.

Implementation of immunohistochemistry on frozen ear notch tissue samples in diagnosis of bovine viral diarrhea virus in persistently infected cattle.

BACKGROUND: Bovine viral diarrhea is a contagious disease of domestic and wild ruminants and one of the most economically important diseases in cattle. Bovine viral diarrhea virus belongs to the genus Pestivirus, within the family Flaviviridae. The identification and elimination of the persistently infected animals from herds is the initial step in the control and eradication programs. It is therefore necessary to have reliable methods for diagnosis of bovine viral diarrhea virus. One of those methods is immunohistochemistry. Immunohistochemistry on formalin fixed, paraffin embedded tissue is a routine technique in diagnosis of persistently infected cattle from ear notch tissue samples. However, such technique is inappropriate due to complicated tissue fixation process and it requires more days for preparation. On the contrary, immunohistochemistry on frozen tissue was usually applied on organs from dead animals. In this paper, for the first time, the imunohistochemistry on frozen ear notch tissue samples was described. FINDINGS: Seventeen ear notch tissue samples were obtained during the period 2008-2009 from persistently infected cattle. Samples were fixed in liquid nitrogen and stored on -20°C until testing. Ear notch tissue samples from all persistently infected cattle showed positive results with good section quality and possibility to determinate type of infected cells. CONCLUSIONS: Although the number of samples was limited, this study indicated that immunohistochemistry on formalin fixed paraffin embedded tissue can be successfully replaced with immunohistochemistry on frozen ear notch tissue samples in diagnosis of persistently infected cattle.

Severe ear chondritis due to cowpox virus transmitted by a pet rat.

We describe a case of cowpox virus infection leading to severe acute inflammation and chondritis of the outer ear, complicated by local necrosis and facial cellulitis. Secondary lesions occurred on a finger and the abdomen. Apart from scarring, outcome was favorable after repeated surgical excision of necrotic tissue.

Squamous cell carcinoma arising in discoid lupus erythematosus lesions of the ears infected with human papillomavirus.

We describe a 51-year-old white man with discoid lupus erythematosus (DLE) of the head, neck, trunk, and upper extremities of more than 20 years' duration who developed rapidly progressive squamous cell carcinoma (SCC) of the bilateral ear helices. Human papillomavirus (HPV) was detected from excised specimens from the ears via tissue immunohistochemistry. Human papillomavirus infection of discoid lesions may be responsible for the rapid progression of SCC of this patient's bilateral ear helices.

Monitoring for bovine viral diarrhea virus in Austrian red deer (Cervus elaphus elaphus) by using ear-notch samples.

During 2007-09, ear-notch samples from free-living (n=527) and farmed (n=237) Austrian red deer (Cervus elaphus elaphus) were tested for bovine viral diarrhea virus type 1 (BVDV-1) and type 2 (BVDV-2) by enzyme-linked immunosorbent assay and single-tube real-time reverse transcription PCR. Ear-notch samples were collected by applying modified ear tags from randomly selected hunter-harvested red deer and from individuals originating from deer holdings. All samples tested negative for BVDV-1 and BVDV-2. Results of this study show no evidence of persistently infected animals. They indicate further that BVDV is playing a minor role in free-living and farmed red deer in Austria. Ear-notch samples are an effective tool for in vivo and postmortem detection of BVDV in wildlife. This sample collection technique can be easily used in combination with tagging individual wild animals kept in captivity.

Absence of Epstein-Barr virus, human papillomavirus, and simian virus 40 in patients of central european origin with lymphoepithelioma-like carcinoma of the skin.

The authors report 10 cases of lymphoepithelioma-like carcinoma (LELC) of the skin and the results of a molecular biological study for HPV, EBV, and SV40 in lesional tissues. All patients originated from Central Europe. There were seven men and three women, ranging in age from 57 to 86 years. Locations included the face (n = 4), scalp (n = 2), penis (n = 2), and retroauricular area (n = 1); location was unknown for one subject. All but two patients presented with a tumor confined to the skin; in both patients with the penile carcinoma, the tumors had metastasized to an inguinal lymph node. Six patients with available follow-up included four individuals with no evidence of tumor metastasis or recurrences at 2, 3, 4, and 5 years, one patient who died with metastatic disease 7 years after diagnosis, and one patient who died of an unrelated course. Microscopically, all cases showed distinctive features of LELC characterized by variably sized and shaped nodules or syncytial sheets of epithelial cells that contained vesicular chromatic and prominent nucleoli and that were permeated and surrounded by small, well-differentiated lymphocytes and plasma cells. Because all 10 cases studied proved negative for EBV, HPV, and SV40, these viruses seem to play no causal role in LELC of the skin in patients from Central Europe.

Variation in E(rns) viral glycoprotein associated with failure of immunohistochemistry and commercial antigen capture ELISA to detect a field strain of bovine viral diarrhea virus.

Bovine viral diarrhea virus (BVDV) affects cattle populations causing clinical signs that range from subclinical immunosuppression to severe reproductive and respiratory problems. Detection and removal of persistently infected (PI) calves is the single most important factor for control and eradication of BVDV. Current testing strategies to detect PI calves rely heavily on immunohistochemistry (IHC) and a commercially available antigen capture ELISA (ACE) assay. These viral assays depend on 1 or 2 monoclonal antibodies which target the E(rns) glycoprotein of BVDV. The sensitivity and specificity of these two tests have been reported previously. The purpose of this research was to characterize a strain of BVDV (AU501) that was undetectable using IHC and ACE based on a single monoclonal antibody, but was consistently detected in samples from a Holstein steer using virus isolation and PCR testing. Sequencing of this AU501 viral isolate revealed a unique mutation in the portion of the genome coding for the E(rns) glycoprotein. This unique field strain of BVDV demonstrates the risk of relying on a single monoclonal antibody for detection of BVDV. Multiple testing strategies, including polyclonal or pooled monoclonal antibodies that detect more than one viral glycoprotein may be necessary to detect all PI calves and facilitate eradication of BVDV.

Reverse transcription-polymerase chain reaction on pooled samples to detect bovine viral diarrhea virus by using fresh ear-notch-sample supernatants.

Ear-notch samples from 3,599 yearling heifers were collected to detect persistently infected (PI) animals with suspect bovine viral diarrhea virus (BVDV). Individual immunohistochemistry (IHC), individual antigen-capture enzyme-linked immmunosorbent assay (AC-ELISA), and reverse transcription-polymerase chain reaction (RT-PCR) tests with pooled ear-notch supernatants were compared with samples from 3,016 heifers, whereas RT-PCR ear-notch pools and individual AC-ELISA tests were compared with samples from all 3,599 heifers. Four heifers were identified positive by both IHC and AC-ELISA, whereas the remaining heifers were identified negative by both tests. When supernatant from ear notches from 100 animals was randomly pooled and RT-PCR was accomplished on each pool, RT-PCR identified 2 pools that contained 1 positive AC-ELISA sample and 1 pool that contained 2 positive AC-ELISA samples. Further evaluation of the pooled RT-PCR ear-notch supernatant detected 100% (n = 36) samples spiked with supernatant from a single randomly selected positive AC-ELISA ear notch. Although follow-up confirmatory tests were not completed, all 3 methods correlated 100% in detecting suspect PI animals, with a kappa value of 1. The use of RT-PCR on pooled ear-notch supernatant could provide an initial, rapid, cost-effective method of screening cattle herds for BVDV PI animals. Subsequent serial testing with an AC-ELISA to evaluate individual samples included in the positive pool could minimize the length of time other animals are exposed to the virus.

Association between the existence of calves persistently infected with bovine viral diarrhea virus and commingling on pen morbidity in feedlot cattle.

OBJECTIVE: To determine the association between the existence of a calf persistently infected (PI) with bovine viral diarrhea virus (BVDV) and pen morbidity. ANIMALS: 5,041 calves in 50 pens at a feedlot in Iowa. PROCEDURE: In a longitudinal study, ear notches were collected from cattle and tested for BVDV antigen. Characteristics of each pen (owner, sex, disease rate, number of groups, and source) were recorded. The association between the existence of a BVDV-PI calf and morbidity in each pen was examined. RESULTS: Commingling was associated with an increase in respiratory tract disease (odds ratio [OR], 3; 95% confidence interval [CI], 2.5 to 3.6). Ten BVDV-PI calves (10/5,041 [0.2%]) were identified in 8 of 50 pens. A BVDV-PI calf was associated with reduced pen-level respiratory tract disease (OR, 0.7; 95% CI, 0.5 to 0.9). Disease prevalence (mean +/- SD morbidity, 7.9 +/- 3.1%) was lowest in pens containing single-source cattle and a BVDV-PI calf (4 pens containing 302 cattle), compared with single-source cattle with no BVDV-PI calf (mean morbidity, 11.89 +/- 9.7%; 31 pens containing 3,093 cattle), commingled cattle with no BVDV-PI calf (mean morbidity, 29.3 +/- 16.22%; 11 pens containing 1,127 cattle), and commingled cattle with a BVDV-PI calf (mean morbidity, 28.6 +/- 10.1%; 4 pens containing 519 cattle). CONCLUSIONS AND CLINICAL RELEVANCE: Commingling was the greatest risk factor associated with morbidity in each pen. A BVDV-PI calf in a pen was not associated with increased disease prevalence in commingled groups.

Evidence for the presence of neutralizing antibodies against human papillomavirus type 6 in infants born to mothers with condyloma acuminata.

Despite human papillomavirus type 6 or 11 (HPV6/11) being often vertically transmitted from mothers with condyloma acuminata (CA) to their infants, HPV-related neonatal mucosal diseases are rare. The role of maternal anti-HPV6/11 neutralizing antibodies in preventing the vertical transmission remains to be unknown because of lack of the neutralization assay system of HPV infection. We experienced two cases of HPV6-positive CA during pregnancy. Neutralizing antibodies against HPV6 in maternal, umbilical, and infantile sera were determined using a surrogate assay system to monitor HPV6 pseudo-infections. The neutralizing antibodies were detected in maternal and umbilical sera and in serum of one of the infants tested at 5 weeks old. In the infant exposed to HPV6 at birth, viral DNA was not detectable in the oral cavity 5 weeks after birth. This is the first report to describe that neutralizing antibodies against HPV6 in mothers with CA go through the placenta and enter the circulation of their infants. These data may provide a mechanistic paradigm for the prevention of its vertical transmission.

Brain resistance to HSV-1 encephalitis in a mouse model.

Brain resistance to intracerebral superinfections develops after a peripheral inoculation of neurovirulent viruses. Superinfection resistance combines specificity, toward the virus used for the peripheral inoculum, and short-term duration after the inoculum. In order to study this unusual combination, neurovirulent superinfections were made on albino Swiss mice previously infected with a nasal inoculum. A herpesvirus strain SC16, or a homologue recombinant virus carrying the reporter lac Z gene or a vesicular stomatitis virus (VSV) (a virus taxonomically unrelated to Herpesviridae) were used. The mice underwent a neurological examination and their survival rate was recorded. The brains superinfected with the reporter virus were stained for the beta-galactosidase reaction to trace the virus spread and the inflammatory infiltrates were characterized immunocytochemically. The results confirm and extend previous observations about virus specificity and short-term duration of superinfection resistance. They show, moreover, an enhanced brain inflammation with T-cells and macrophages infiltrating the tissue around microvessels, at a time when both neurovirulence and the spread of herpesvirus in the brain are reduced. The results suggest that the immune response to superinfection in the nervous tissue is enhanced by blood-brain barrier mechanisms that promote the timely extravasation of immune cells.

Role of the C-terminal RDEL motif of the myxoma virus M-T4 protein in terms of apoptosis regulation and viral pathogenesis.

The purpose of this study was to investigate the significance of the C-terminal RDEL motif of the myxoma virus M-T4 protein in terms of apoptosis regulation and role in viral virulence. To accomplish this, a recombinant myxoma virus was created in which the C-terminal RDEL motif of M-T4 was deleted and a selectable marker (Ecogpt) was inserted immediately downstream. We hypothesized that removal of the RDEL motif from M-T4 would alter the subcellular localization of the protein and provide insight into its antiapoptotic role. Surprisingly, removal of the RDEL motif from M-T4 did not affect localization of the protein within the endoplasmic reticulum (ER), but it did reduce the stability of the mutant protein. Pulse-chase immunoprecipitation and endoglycosidase H analysis coupled with confocal fluorescent light microscopy demonstrated that the M-T4 RDEL(-) mutant protein is retained in the ER like wildtype M-T4 and suggests that the C-terminal RDEL motif is not the sole determinant for M-T4 localization to the ER. Infection of cultured rabbit lymphocytes with the M-T4 RDEL(-) mutant virus results in an intermediate apoptosis phenotype compared with the wildtype and M-T4 knockout mutant viruses. A novel myxomatosis phenotype was observed in European rabbits when infected with the recombinant M-T4 RDEL(-) mutant virus. Rabbits infected with the M-T4 RDEL(-) virus on day 9 postinfection exhibited an exacerbated edematous and inflammatory response at secondary sites of infections, particularly the ears. Our results indicate that the C-terminal RDEL motif may not be solely responsible for retention of M-T4 to the ER and that M-T4 may have a dual function in protecting infected lymphocytes from apoptosis and in modulating the inflammatory response to virus infection.

Comparison of effects of famciclovir and valaciclovir on pathogenesis of herpes simplex virus type 2 in a murine infection model.

The effects of famciclovir (FCV) and valaciclovir (VACV) were compared in a cutaneous infection model for herpes simplex virus type 2 (HSV-2). The compounds were administered orally from day 1 to day 5 postinfection. Both compounds reduced local inflammation and virus replication in the skin. FCV markedly reduced mortality and virus replication in the nervous system. On the cessation of therapy after 5 days, when the levels of infectious virus in the tissues were reduced to below the level of detection, there followed a rebound of virus replication in the ganglia and brain stems of mice that had been treated with VACV. The recurrence of infection in the brain stem occurred on three separate occasions. No such recurrences were observed following FCV treatment. When ganglia were explanted from survivors 6 weeks later, latent virus was shown to be reactivated in all 10 of 10 control, untreated mice. The number of mice whose ganglia yielded virus was reduced to 60% in mice that had been treated with VACV, whereas no mice that had been treated with FCV had evidence of latent infection by this test.

Differential effects of famciclovir and valaciclovir on the pathogenesis of herpes simplex virus in a murine infection model including reactivation from latency.

The ability of famciclovir and valaciclovir to affect the establishment and maintenance of latency in mice with a cutaneous herpes simplex type 1 (HSV-1) infection was examined. Mice were treated via drinking water starting at various times between days 1 and 5 and terminating on day 10 after inoculation. Clinical signs and viral replication in the target tissues were monitored. Three to four months later, trigeminal and dorsal root ganglia were explanted from groups of 16 mice and examined for latent virus by cocultivation. The two compounds differed in their effects on the acute neural infection, and ganglia explanted from famciclovir-treated mice were markedly reduced in their ability to reactivate virus, although neither drug affected latency if treatment was delayed for several months. The difference between the compounds is likely to reflect differences in the metabolism of their respective products, penciclovir and acyclovir, in infected neurons.