Causal associations between prodromal infection and neuromyelitis optica spectrum disorder: A Mendelian randomization study.

BACKGROUND AND PURPOSE: Prodromal infections are associated with neuromyelitis optica spectrum disorder (NMOSD), but it remains unclear which type of infection has a causal association with NMOSD. We aimed to explore the causal associations between four herpesvirus infections (chickenpox, cold sores, mononucleosis and shingles) and NMOSD, as well as between other types of infections and NMOSD. METHODS: For data on infections, we used the genome-wide association study (GWAS) summary statistics from the 23andMe cohort. For outcomes, we used the GWAS data of participants of European ancestry, including 215 NMOSD patients (132 anti-aquaporin-4 antibody [AQP4-ab]-positive patients and 83 AQP4-ab-negative patients) and 1244 normal controls. Single-nucleotide polymorphism (SNP) identification and two-sample Mendelian randomization (MR) analyses were then performed. RESULTS: In the 23andMe cohort, we identified one SNP for chickenpox (rs9266089 in HLA-B gene), one SNP for cold scores (rs885950 in the POU5F1 gene), one SNP for mononucleosis (rs2596465 in the HCP5 gene), and three SNPs for shingles (rs2523591 in the HLA-B gene; rs7047299 in the IFNA21 gene; rs9260809 in the MICD gene). The association between cold sores and AQP4-ab-positive NMOSD reached statistical significance (odds ratio [OR] 745.318; 95% confidence interval [CI] 22.176, 25,049.53 [p < 0.001, Q < 0.001]). The association between shingles and AQP4-ab-positive NMOSD was also statistically significant (OR 21.073; 95% CI 4.271, 103.974 [p < 0.001, Q < 0.001]). No significant association was observed between other infections and AQP4-ab-positive or AQP4-ab-negative NMOSD. CONCLUSION: These findings suggest there are positive associations between cold sores and shingles and AQP4-ab-positive NMOSD, indicating there may be causal links between herpes simplex virus and varicella-zoster virus infection and AQP4-ab-positive NMOSD.

Recurrent herpes labialis in the pediatric population: Prevalence, therapeutic studies, and associated complications.

Recurrent herpes labialis (RHL) is an incredibly common condition, though the medical literature evaluating pediatric aspects is limited. This paper assesses prevalence and therapeutic studies of pediatric RHL as well as disease complications. A comprehensive literature search of English-language citations based on PubMed queries of selected terms was performed, with exclusion if methodology was not discussed, or if studies had 10 or fewer patients. RHL prevalence in pediatrics has been assessed by measures of point and periodic prevalence, though methodologic limitations may under- or over-estimate the true prevalence of RHL. Studies have been conducted to evaluate therapeutic safety, tolerability, and efficacy of antivirals in the pediatric population. Pediatric RHL point prevalence ranges from 0.72% to 5.2% depending on the population study and the methodologies used. Pediatric RHL carries a significant public health burden and is often implicated in patients with eczema herpeticum, erythema multiforme, reactive infectious mucositis eruptions, and hypersensitivity reactions. There are few studies that evaluate the rates of occurrence of these sequelae associated with pediatric RHL.

Erythema multiforme: Differences between HSV-1 and HSV-2 and management of the disease-A case report and mini review.

Erythema multiforme (EM) is an immune-mediated reaction characterized by target lesions and with possible mucosal involvement. Its most frequent cause is HSV, with HSV-1 more common than -2. It is usually self-limited but it can show recurrences. We report a peculiar case of recurrent herpes-associated erythema multiforme (HAEM) in a 35-year-old man. The patient was affected by both herpes labialis and genitalis, but the typical target lesions were only associated with recurrent herpes labialis. Here, we hypothesize about the pathogenic differences between HSV-1 and HSV-2, and discuss the therapeutic management of HAEM.

Recurrent Herpes Labialis in Adults: New Tricks for an Old Dog.

Herpes labialis remains a common worldwide affliction. Recent advances in understanding the basic pathogenesis have led to new therapeutic intervention, both on-label and off-label. Aside from reducing the duration and symptomatology of acute outbreaks, another goal of treatment is to decrease the frequency of future episodes. Oral and topical acyclovir and its analogues are the mainstay of both chronic suppressive and episodic therapy. A new muco-adhesive formulation of acyclovir provides a decrease in outbreaks, probably due to a diminution of herpesvirus load in all reservoir sites. Acyclovir-resistant strains are rare in immunocompetent hosts; parenteral foscarnet and cidofovir are administered in this situation. Parenteral acyclovir is the drug of choice for eczema herpeticum, which may begin as herpes labialis in an atopic dermatitis patient. Thermotherapy may be beneficial, and a certified device to deliver heat is available outside the United States.

J Drugs Dermatol. 2017;16(3 Suppl):s49-53.

Multiorgan Dysfunction Syndrome from Strongyloides stercoralis Hyperinfection in a Patient with Human T-Cell Lymphotropic Virus-1 Coinfection After Initiation of Ivermectin Treatment.

Strongyloides stercoralis is well known to cause hyperinfection syndrome during the period of immunosuppression; but dissemination, worsening hyperinfection, and development of multiorgan dysfunction syndrome after initiation of ivermectin has not been reported in the past. Herein, we describe the case of a 62-year-old man with chronic strongyloidiasis and human T-cell lymphotropic virus-1 coinfection, who developed significant clinical worsening after 24-48 hours of initiation of treatment with ivermectin (200 µg/kg daily). Oral albendazole (600 mg every 12 hours) was added to the regimen due to clinical deterioration. Notably, after a protracted clinical course with multiple complications, which included respiratory failure from gram-negative pneumonia and pulmonary alveolar hemorrhage, Klebsiella meningitis, Clostridium difficile colitis, and herpes labialis, the patient eventually recovered. Health-care providers should be aware that during the early days of antihelminthic treatment initiation, significant dissemination of S. stercoralis and worsening of the clinical scenario can occur.

Esclerosi múltiple: un repte diagnòstic a pediatria / Esclerosis múltiple: un reto diagnóstico en pediatría / Multiple sclerosis: a diagnostic challenge in pediatrics

Introducció: l'esclerosi múltiple (EM) és la malaltia desmielinitzant primària del sistema nerviós central (SNC) més comuna. Sol manifestar-se amb episodis de focalitat neurològica amb curs remitentrecurrent. Entre el 2 i el 5% dels casos debuten en la infància. Es descriu un cas de malaltia primària de l'SNC suggestiu d'EM, en què es remarca la importància de fer un bon diagnòstic diferencial i es ressalten els nous criteris diag-nòstics d'EM pediàtrica. Cas clínic: nena de 12 anys que es presenta amb clínica d'una setmana d'evolució d'hipoestèsia en territori trigemi-nal esquerre i extremitat superior dreta. Herpes labial actiu. Vacunada del virus de l'hepatitis B i del virus del papil•loma humà vuit mesos abans. Estudi de neuroimatge amb ressonància magnètica nuclear (RM) cerebral que mostra lesions desmielinitzants a substància blanca en hemisferi cerebral esquerre i hemiprotuberància dreta, algunes amb signes d'activitat. Líquid cefaloraquidi (LCR) sense proteïnoràquia ni pleocitosi, amb bandes oligoclonals d'IgG de síntesi intratecal. Reacció en cadena de polimerasa (PCR) d'herpes virus en LCR negativa. El quadre clínic i les lesions de l'RM orienten al diagnòstic amb alta sospita d'EM. Comentaris: les malalties desmielinitzants de l'SNC plante-gen un ampli diagnòstic diferencial. La presència de serologies positives en sèrum orienta a una malaltia desmielinitzant com l'encefalomielitis aguda disseminada (EMAD) en què és freqüent un mecanisme postinfecciós. La neuroimatge és molt útil en el diagnòstic de les malalties desmielinitzants. Les bandes oligoclonals, els anticossos anti-AQP4/NMO (neuromielitis òptica) i els anticossos anti-MOG (mielina de l'oligodendròcit) poden ser de gran ajuda en el diagnòstic de les malalties desmielinitzants

Introducción. La esclerosis múltiple (EM) es la enfermedad desmielinizante primaria del sistema nervioso central (SNC) más común. Suele manifestarse con episodios de focalidad neurológica con curso remitente-recurrente. Entre el 2 y el 5% de los casos debutan en la infancia. Se describe un caso de enfermedad primaria del SNC sugestivo de EM, remarcando la importancia de hacer un buen diagnóstico diferencial y resaltando los nuevos criterios diagnósticos de EM pediátrica. Caso clínico. Niña de 12 años que se presenta con clínica de una semana de evolución de hipostesia en territorio trigeminal izquierdo y extremidad superior derecha. Herpes labial activo. Vacunada de virus de la hepatitis B y de virus del papiloma humano ocho meses antes. Estudio de neuroimagen con resonancia magnética nuclear (RM) cerebral que muestra lesiones desmielinizantes en sustancia blanca de hemisferio cerebral izquierdo y hemiprotuberancia derecha, algunas con signos de actividad. Líquido cefalorraquídeo (LCR) sin proteinorraquia ni pleocitosis, con bandas oligoclonales de IgG de síntesis intratecal. Reacción en cadena de polimerasa (PCR) de herpes virus en LCR negativa. El cuadro clínico y las lesiones de la RM orientan al diagnóstico con alta sospecha de EM. Comentarios. Las enfermedades desmielinizantes del SNC plantean un amplio diagnóstico diferencial. La presencia de serologías positivas en suero orienta a una enfermedad desmielinizante como la encefalomielitis aguda diseminada (EMAD), en que es frecuente un mecanismo post-infeccioso. La neuroimagen es muy útil en el diagnóstico de las enfermedades desmielinitzantes. Las bandas oligoclonales, los anticuerpos anti-AQP4/NMO (neuromielitis óptica) y los anticuerpos anti-MOG (mielina del oligodendrocito) podrían ser de gran ayuda en el diagnóstico de enfermedades desmielinizantes (AU)

Introduction. Multiple sclerosis (MS) is the most common primary demyelinating disease of the central nervous system (CNS). It usually manifests with episodes of neurological deficits that follow a relapsing-remitting course, and approximately 2-5% of the cases have an onset during childhood. We describe a case of primary demyelinating disease of the CNS suggestive of MS, we emphasize the importance of a proper differential diagnosis, and highlight the new diagnostic criteria for pediatric MS. Case report. A 12-year old girl presented with a one-week history of hypoesthesia in the left trigeminal dermatome and the right upper extremity, and active cold sores. There was history of hepatitis B and human papilloma virus immunization eight months prior. A brain magnetic resonance imaging (MRI) showed demyelinating lesions in the left hemisphere and right medulla oblongata; some of them enhanced with gadolinium. Cerebrospinal fluid (CSF) showed normal protein and absence of pleocytosis, but with oligoclonal bands of intratechal synthesis. Polymerase chain reaction for herpes virus was negative. The clinical and MRI lesions suggested the diagnosis or a primary CNS demyelinating disease, with high suspicion for MS. Comments. Demyelinating diseases of the CNS include a broad differential diagnosis. The presence of positive serology may suggest the diagnosis of acute disseminated encephalomyelitis (ADEM), which is a post-infectious process. Neuroimaging may be very useful in the diagnosis of demyelinating diseases. In addition, oligoclonal bands, anti-AQP4/NMO (neuromyelitis optica) antibodies, and anti-MOG (myelin oligodendrocyte) antibodies may be helpful in the diagnosis (AU)

Postherpetic Nevocentric Erythema Multiforme.

A previously healthy 35-year-old Caucasian woman presented with abrupt onset of erythematous, mildly pruritic plaques surrounding the majority of the nevi present on her neck, chest, back, and upper and lower extremities. She denied history of any recent systemic illnesses and was not taking any medications. On further questioning, the patient reported a recent episode of recurrent herpes labialis 2 weeks prior. The patient has a Fitzpatrick type I skin type with more than 100 brown and reddish brown pigmented macules and papules over her entire body. Plaques ranged in size from 0.4 cm to 1.5 cm depending on the size of the corresponding nevus. The patient's skin was examined in its entirety, and there were no lesions suspicious for melanoma. Two biopsies were performed from the patient's back: one from the nevus itself and another from the surrounding erythematous plaque. The nevocentric erythematous plaques were visible for approximately 1 week at which time they gradually disappeared without treatment. As these areas improved, the patient noticed targetoid lesions on the dorsal hands without associated nevi. Two weeks later, the targetoid lesions had spontaneously resolved.

[Using cycloferon in the complex treatment of herpetic infection in patients with atopic dermatitis].

Clinical efficacy of including cycloferon liniment in combined treatment of herpetic infection in a group of 40 patients with atopic dermatitis has been analyzed. It is concluded that the administration of cycloferon favors dynamic disappearance of general infectious syndrome, reduces timeline of rash as well as length of local inflammation, accelerates epithelization of erosions (on the average 1.2 - 1.4 times, p < 0.05), decreases frequency of recurrent infections, and reduces the level of pro-inflammatory cytokines in the blood of patients.

Antisynthetase syndrome: two cases presenting orofacial manifestations.

Antisynthetase syndrome is a rare autoimmune disease that is characterised by inflammatory myositis, and interstitial lung disease or chronic arthropathy, or both. To the best of our knowledge, orofacial manifestations have not previously been reported. We present 2 patients with orofacial disease: one with aphthous-like oral ulceration and the other with hyposalivation.

Clinical and cytologic features of antibiotic-resistant acute paronychia.

BACKGROUND: Acute paronychia usually is treated as a bacterial infection, but antibiotic-resistant acute paronychia may be caused by other infectious and noninfectious problems. OBJECTIVE: We sought to describe the clinical, etiologic, cytologic, and therapeutic features of antibiotic-resistant acute paronychia. METHODS: A retrospective review of medical records and cytology was performed in 58 patients (age, 1 month-91 years; 36 children and adolescents [62%] and 22 adults [38%]) who had antibiotic-resistant acute paronychias. RESULTS: Causes of paronychia included bacteria (25 patients [43%]), viruses (21 patients [36%]), fungi (5 patients [9%]), drugs (3 patients [5%]), pemphigus vulgaris (3 patients [5%]), and trauma (1 patient [2%]). Diagnostic cytologic findings were noted in 54 patients (93%); no diagnostic cytologic findings were present with drug-induced (3 patients) or traumatic (1 patient) paronychia. The most common predisposing factors were the habits of finger- or thumb-sucking (14 patients [24%]) and nail-biting (11 patients [19%]). Complications included id reaction with erythema multiforme in 3 patients (5%). LIMITATIONS: Limitations include retrospective study design from 1 treatment center. CONCLUSION: Antibiotic-resistant acute paronychia may be infectious or noninfectious. Cytologic examination with Tzanck smear may be useful diagnostically and may prevent unnecessary use of antibiotics and surgical drainage.

Human herpes virus associated with Hashimoto's thyroiditis.

Hashimoto's thyroiditis is the most frequent autoimmune disease with genetic and environmental aetiologies. Viral infections have been postulated as one of the factors that may trigger autoimmune diseases. Many studies suggest that Herpes simplex virus infections are involved in a variety of autoimmune diseases. We report the case of three patients presenting for the first time herpes labialis a few months before the onset of hashitoxicosis. Serological and clinical exams support the possible role of human herpes viruses in the aetiology of Hashimoto's thyroiditis.

The study of role of stress in children with behavior disorders and orofacial lesions.

AIM: (1) To study the behavior disorders in children between 5 to 15 years. (2) To study the role of stress in causing behavior disorders. (3) To interpret the orofacial findings in children with behavior disorders. (4) Correlate the orofacial findings with behavior disorder. MATERIALS AND METHODS: Ninty children with behavior problems between age of 5 to 15 years along with their parents who visited the Department of Child-Guidance Clinic, BYL Nair Charitable Hospital, Mumbai. Intraoral examinations were conducted. Behavioral disorders and factors predisposing to those disorders were recorded. RESULTS: Behavior disorders with orofacial lesions was more common in age group of 8 to 10 years. The children were continuously under stress, which manifested in the form of various orofacial disorders or oral lesions. Most common orofacial condition was bruxism. CONCLUSION: Awareness of behavior disorders in dental treatment should guide the pediatric dentist to seek child psychiatric consultation for behavioral disorders to enable early evaluation of the underlying disorder. CLINICAL SIGNIFICANCE: The present study suggested that orofacial and behavior characteristics can serve as markers to diagnose children with behavioral disorders. It also serves as a guide to dental clinicians to refer such children to psychiatrists or pediatricians for early identification, prevention and treatment.