Common Features Between Stroke Following Varicella in Children and Stroke Following Herpes Zoster in Adults : Varicella-Zoster Virus in Trigeminal Ganglion.

The cerebral arteries are innervated by afferent fibers from the trigeminal ganglia. Varicella-zoster virus (VZV) frequently resides in the trigeminal ganglion. Reports of arterial ischemic stroke due to VZV cerebral vasculopathy in adults after herpes zoster have been described for decades. Reports of arterial ischemic stroke due to post-varicella cerebral arteriopathy in children have also been described for decades. One rationale for this review has been post-licensure studies that have shown an apparent protective effect from stroke in both adults who have received live zoster vaccine and children who have received live varicella vaccine. In this review, we define common features between stroke following varicella in children and stroke following herpes zoster in adults. The trigeminal ganglion and to a lesser extent the superior cervical ganglion are central to the stroke pathogenesis pathway because afferent fibers from these two ganglia provide the circuitry by which the virus can travel to the anterior and posterior circulations of the brain. Based on studies in pseudorabies virus (PRV) models, it is likely that VZV is carried to the cerebral arteries on a kinesin motor via gE, gI and the homolog of PRV US9. The gE product is an essential VZV protein.

Birth palsy in congenital varicella syndrome: A lesson in anatomy.

While brachial plexus palsy sustained due to birth trauma is well known, congenital palsies are decidedly rare. We report such a case caused by congenital varicella syndrome, with associated congenital Horner's syndrome and heterochromia iridis. The surprising juxtaposition of a classic upper plexus palsy and a Horner's syndrome raises points of interest. Similar reports in literature are reviewed, and the genesis of a very characteristic group of findings is discussed.

Congenital varicella syndrome: A systematic review.

Varicella-zoster virus (VZV) is a teratogen that can cross the placenta and cause the congenital varicella syndrome (CVS), which is characterised by multi-system anomalies. There have been 130 reported cases of CVS from 1947 to 2013. The estimated incidence of CVS was 0.59% and 0.84% for women infected with VZV during the entire pregnancy and for those infected the first 20 weeks of pregnancy, respectively. Nine cases were reported at 21-27 weeks of gestation and one case was identified at 36 weeks. Herpes zoster caused CVS in two cases. Regarding treatment, varicella zoster immunoglobulin treatment, irrespective of gestational age, should be considered in addition to antiviral drugs for women who have been exposed to or infected with virus.

Congenital varicella syndrome in a monochorionic diamniotic twin pregnancy.

Congenital varicella syndrome encompasses a broad spectrum of malformations present in children of mothers who developed chickenpox during the first 20 weeks of gestation. We report a case of a monochorionic diamniotic twin pregnancy, with maternal exposure to chickenpox during the thirteenth week of gestation, which produced one symptomatic and one healthy child.

Active prospective national surveillance for congenital and neonatal varicella in Australia shows potential prevention opportunities.

To compare the incidence and outcomes of congenital and neonatal varicella in Australia in the pre-vaccination (1995-1997) and post-vaccination era (after 2005 to November 2020), active prospective national surveillance for congenital varicella syndrome (CVS) and neonatal varicella infection (NVI) was conducted through the Australian Paediatric Surveillance Unit (APSU). Compared with 1995-1997, there was a 91.5% reduction in the incidence of CVS and a 91.3% reduction in the incidence of NVI in 2009-2020. However, almost half of the mothers in 2009-2020 were born overseas and came from countries without a vaccination program. Although there has been a substantial and sustained decrease in the reported incidence of CVS and NVI in Australia since 2006, congenital and neonatal varicella infections persist. Thus, there is an opportunity for targeted screening of varicella in young migrant, asylum seeker and refugee women at risk of varicella infection and prioritisation for vaccination to prevent CVS and NVI.

Congenital and Perinatal Varicella Infections.

Varicella-zoster virus (VZV) is a human pathogen of the α-herpesvirus family. Some fetuses infected in utero around 8-20 weeks of pregnancy show signs of congenital varicella syndrome (CVS). Infants born to mothers who develop varicella within 5 days before and 2 days after delivery can experience severe disease with increased mortality. The best diagnostic modality is polymerase chain reaction (PCR), which can be done using vesicular swabs or scrapings, scabs from crusted lesions, tissue from biopsy samples, and cerebrospinal fluid. The prevention and management of varicella infections include vaccination, anti-VZV immunoglobulin, and specific antiviral drugs. In this article, we have reviewed the characteristics of VZV, clinical manifestations, management of perinatal infections, and short- and long-term prognosis.

How to manage chickenpox during pregnancy: case reports.

Chickenpox is a human infection that occurs mainly during childhood. Infection during pregnancy is therefore rare but may cause a congenital infection with malformation in less than 1% of cases. A specific management should be proposed at diagnosis in order to reduce materno-fetal transmission and morbimortality. Three cases were herein presented focusing on the main at-risk situations for pregnant women, whom immunological status against varicella was unknown. The first case focused on a varicella eruption during early pregnancy that leads to a lethal outcome. The second one described the management of varicella contact during early pregnancy. This woman was treated by specific immunoglobulins, leading to a positive outcome. The third case focused on another varicella contact, at the end of pregnancy. The woman was treated by acyclovir, before and after delivery, to limit materno-fetal consequences. In conclusion, after a suspicious contact, a serology assay has to be performed to know the immune status of the pregnant woman against varicella. In case of seronegativity, prevention against varicella infection should be carried out using specific immunoglobulins or valacyclovir. Clinical varicella does not require virology confirmation but requires immediate treatment with valacyclovir especially when it occurs during the first trimester.

Falla de inmunoglobulina específica varicela zoster en prevenir varicela neonatal: revisión a propósito de un caso clínico / Failure of varicella zoster specific immunoglobulin to prevent neonatal varicella: a review regarding a clinical case

La varicela neonatal es una patología grave. En Chile recientemente se incorporó la vacuna varicela al programa nacional de inmunizaciones, por lo que es aún es esperable que ocurra transmisión vertical. El manejo en el recién nacido incluye inmunoglobulina específica para virus varicela zoster cuando la madre inicia una varicela periparto. Presentamos el caso clínico de un neonato que cursó con una varicela grave pese a haber recibido profilaxis con inmunoglobulina específica. Se realizó una revisión de la literatura sobre varicela neonatal para sugerir recomendaciones de manejo. El uso de inmunoglobulina específica para virus varicela zoster, como profilaxis a un recién nacido expuesto, disminuye el riesgo de varicela neonatal pero no lo elimina.

Neonatal chickenpox is a serious pathology. In Chile, the varicella vaccine was recently incorporated into the national immunization program, so vertical transmission is still expected. Newborn management includes specific immunoglobulin for varicella zoster virus when the mother initiates peripartum chickenpox. We present a case of a newborn who has severe chickenpox despite having received prophylaxis with immunoglobulin, and a review of the literature on neonatal chickenpox was carried out to suggest management recommendations. The use of specific immunoglobulin for varicella zoster virus as prophylaxis in an exposed newborn reduces the risk of neonatal chickenpox but does not eliminate it.

Microbiology laboratory and the management of mother-child varicella-zoster virus infection.

Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn.

Congenital and perinatally-acquired infections in resource-constrained settings.

INTRODUCTION: Congenital and perinatal infections are a leading cause of neonatal and infant morbidity and mortality. Maternal screening, vaccines or treatment where available, constitute effective prevention strategies to reduce the burden of these diseases. Data on the burden of congenital and perinatal infections are very limited for low and middle-income regions. AREAS COVERED: This review aims to summarize the burden of congenital and perinatal infections and the main challenges for their control in resource-limited settings. Articles were identified through the main electronic databases and cover the period 1971-2016. Expert commentary: Estimates from low and middle-income countries indicate that the burden of congenital infections may be higher in these regions than in industrialized countries. As preventive and curative strategies are available to tackle some of these infections, efforts at the international and national levels must be made to implement those and thus reduce their burden in resource-limited countries.

Management of varicella-zoster virus primary infection during pregnancy: A national survey of practice.

BACKGROUND: Varicella (VZV) infection in pregnancy can result in serious outcomes: maternal pneumoniae irrespective of the term of pregnancy, and lead to congenital varicella syndrome before 18 weeks of gestation and neonatal varicella. There are between 350 and 500 cases a year in France. Until now, there have been no scientific obstetrical guidelines for clinical practice in France for VZV infection during pregnancy. OBJECTIVES: To evaluate health care providers' knowledge and practices concerning varicella infection during pregnancy in France. STUDY DESIGN: An anonymous survey on VZV infection was sent by e-mail to gynecologists-obstetricians and midwives. We evaluated their knowledge and practices concerning VZV transmission, maternal varicella, congenital varicella syndrome, neonatal varicella and prevention. RESULTS: The survey was completed by 271 professionals: gynecologists (161/271; 60%) and midwives (110/271; 40%). Among 20 items, 5 were multiple choice questions. 29 correct answers were expected. Scores ranged from 6/29 to 28/29 (mean score: 17.44/29). CONCLUSIONS: The consequences of VZV primary infection in pregnancy are poorly known. We reveal a diversity of management among practitioners in our study population, not always in accordance with the international scientific literature or with the guidelines of other countries. Health care providers should update their knowledge of varicella infection during pregnancy. The publication of national guidelines could help to achieve this objective.

Atención al neonato expuesto o infectado con el virus varicela-zoster / Care to the neonates exposed or infected with the varicella-zoster virus

La gestante con varicela en el primer trimestre puede trasmitir la infección a la descendencia, en cuyo caso hay riesgo de aborto o de muerte fetal o de secuelas permanentes en el producto de la gestación. El objetivo de esta comunicación es actualizar a los perinatólogos, neonatólogos y epidemiológicos en la atención al neonato expuesto o infectado por el virus de la varicela zoster en el contexto nacional. La infección por el virus en el periodo neonatal puede ser grave y fatal en prematuros extremos, en pretérminos hijos de madres sin exposición previa al virus y en recién nacidos cuyas madres hayan iniciado el exantema cinco días antes del parto o hasta dos días posteriores a este. La varicela es prevenible por vacuna y en los países desarrollados, existe una gammaglobulina específica contra el virus de la varicela zoster para ser aplicada en expuestos a este virus con alto riesgo de presentar formas graves de la enfermedad. En el contexto nacional, la infección por el virus de la varicela, es frecuente y la inmunización activa y pasiva no está disponible, por lo que es necesario estar actualizado en la atención de los grupos vulnerables de padecer esta infección(AU)

The pregnant woman with varicella in the first quarter of pregnancy can transmit the infection to the fetus, in which case there is a risk of miscarriage or fetal death or permanent sequelae in the product of the gestation. The aim of this communication is to upgrade perinatologists, neonatologists and epidemiologists in the management of the neonate exposed or infected by the varicella-zoster virus in the national context. The infection by the virus in the neonatal period can be serious and fatal in extremely premature neonates, in preterm children of mothers without previous exposure to the virus and in newborns whose mothers have showned exanthem five days before delivery or up to two days after this. Varicella is preventable by vaccination and in developed countries there is a specific gammaglobulin against the varicella-zoster virus to be applied in patients exposed to this virus with high risk of presenting severe forms of the disease. In the national context, the infection by the varicella virus is frequent and active and passive immunization is not available, so it is necessary to be updated in the handling of vulnerable groups to this infection(AU)

Infección por Varicela durante la gestación. Estudio de 16 años / Varicella Infection during Pregnancy. A Sixteen-Year Study

Introducción: el Síndrome de varicela congénita, afecta aproximadamente a 2% de hijos de madres con primoinfección por varicela. Existe consenso sobre el seguimiento ecográfico de estas gestantes, recomendándose la evaluación del crecimiento fetal, mensuraciones de circunferencia cefálica y huesos largos, evaluación de estructuras cerebrales, características del hígado y líquido amniótico. Objetivos: evaluar las consecuencias en el feto de la infección materna por varicela. Material y Métodos: se realizó un estudio retrospectivo, en el que se incluyeron pacientes afectadas por varicela en cualquier momento del embarazo, durante un período de 16 años, quienes asistieron a la consulta de Genética del Hospital "Ramón González Coro". Se colectaron datos de las 133 pacientes evaluadas, en 97 pudo conocerse la evolución del embarazo y recién nacido. Resultados: del total de casos estudiados, en 95 se obtuvieron resultados postnatales y 2 fueron pérdidas fetales, describiéndose en uno de ellos el Síndrome de varicela congénita. En uno de los 95 casos, se describió un déficit visual de un ojo, después de realizarse el seguimiento. La infección fetal por varicela se constató en alrededor de 2% de los casos, si se considera este último referido. Conclusiones: la infección fetal tuvo un comportamiento similar al reportado en la literatura en cuanto a manifestaciones clínicas y porcientos reportados. Las gestantes que sufren infección por varicela, precisan de un mejor seguimiento prenatal, que garantice una buena evolución del embarazo.

Introduction: congenital varicella syndrome affects about 2% of children of mothers with primary infection of chickenpox. There is consensus on this pregnant ultrasound monitoring, recommending the assessment of fetal growth, head circumference and long- bone measurements, assessment of brain structures, characteristics of the liver, and amniotic fluid. Objective: to evaluate the effects on fetus of maternal infection with varicella. Material and Methods: a sixteen-year retrospective study was conducted including patients affected by chickenpox at any time of their pregnancy; they were assisted at genetic service at Ramón González Coro Hospital. Data from 133 patients evaluated were collected. The course of pregnancy and newborn could be known in 97 of them. Results: out of the total of cases studied, postnatal outcomes were obtained in 95; fetal losses occurred in 2, one of them was described as congenital varicella syndrome. A visual deficit in one eye was described in one case during follow-up. Fetal varicella infection was found in about 2% of cases considering the latter referred. Conclusions: fetal infection had a similar pattern to that reported in the literature regarding clinical and percentages. Pregnant women suffering from chickenpox infection need for better antenatal care, to ensure a good pregnancy outcome.

Lesiones cutáneas no cicatrizales como único dato clínico del síndrome de varicela congénita: reporte de un caso / Non-scal skin lesions as the only clinical evidence avalaible for the diagnosis of congenital chicken pox syndrome. Case report

Introducción. Los casos de infección con el virus de varicela zoster en el embarazo pueden tener un curso clínico grave, tanto para la madre como para el producto, con la probabilidad de transmisión vertical del virus y el desarrollo subsiguiente de varicela congénita o varicela neonatal. El síndrome de varicela congénita (SVC) fue descrito en 1947, desde entonces un poco más de 60 casos han sido reportados. Éste consiste en un espectro de anormalidades que incluyen cicatrices con distribución en dermatomas, anormalidades oculares y deformidades en extremidades. Caso clínico. Se describe un raro caso de SVC con compromiso dermatológico, pero sin otras lesiones al nacimiento. La madre padeció varicela en la semana 10 de la gestación. No se encontró algún reporte de recién nacidos con SVC en México. Conclusión. La característica especial del caso es la presencia de lesiones no cicatrizales como único dato clínico, corroborado con serología positiva contra el virus varicela zoster.

Introduction. Varicella infections cases in pregnant women may have a more severe clinical course, and there is also the risk of vertical transmission of the viral infection, with the subsequent development of congenital or neonatal varicella. Cases of congenital varicella syndrome (CVS) were first described in 1947, since then, a little more than 60 cases of CVS have been reported. The CVS consists of a spectrum of anomalies including scaring with derma to mal distribution, ocular abnormalities and limb deformities. Case report. An unusual case of CVS with dermatologic involvement, but without other injuries at birth is described. The mother contracted chicken pox at 10 weeks' gestation. We didn't find any previous report of newborns with CVS in Mexico. Conclusion. The particular condition of this case is the presence of non cicatricial injuries as only clinical data, supported by a positive serology against varicella-zoster virus.