2012.4-16a.comment

DOI: 10.7241/ourd.20124.78.1                                                                     article in PDF
Our Dermatol Online 2012; 3(4): 353
Date of submission: 05.09.2012 / acceptance: 10.09.2012
Conflicts of interest: None
 
A RARE CASE OF HERPES ZOSTER OTICUS IN AN IMMUNOCOMPETENT PATIENT
by

Ganesh Prabhakar Dhavalshankh, Archana Ganesh Dhavalshankh, Vaishali Mhasvekar

COMMENT:

Anca Chiriac, MD, PhD – Nicolina Medical Center, Department of Dermtology, Iasi, Romania


 
Varicella zoster virus (VZV) is an ancient virus. Herpes viruses have existed since the Devonian period, 400 milion years ago [1], when living creatures were represented by sharks, fish, amphibians. The origins of the ancestral VZV date from about 70-100 milion years ago (Cretaceous period) [2], the living creatures were dinosaurs, reptiles, snakes, amphibians, birds and mammals. Between 50-70 milion years ago VZV evolved in ancestral primates (derived from small mammals). In Africa 6 milion years ago VZV existed in hominids, then Homo erectus and finally Homo sapiens carried for a long period of time VZV. Homo sapiens migrated from Africa to China, India, subsequently to Europe. In North America Homo sapiens brought VZV from Asia (via Bering land bridge) 10.000- 15.000 years ago [2]. VZV causes two different disease: chickenpox (typically occurs in children) and herpes zoster (shingles) most often in adults and elderly persons (by the reactivation of latent VZV). Herpes zoster is a neurocutaneous disease characterised by cutaneous lesionsin a the areas of a cranial or spinal nerve. A few short remarks: – usually a prodrome of dermatomal pain precedes the appearance of the rash and subsequent of typical lesions; – the duration and intensity of zoster pain vary greatly even in immnucompetent persons, sometimes postherpetic neuralgia (PHN) may persist months-years and requires neurological consult; – there are patients who experience acute segmental neuralgia without cutaneous eruption (zoster sine herpete); in these cases the rise of VZV antibodies represents a proof of diagnosis; – zoster oticus is rare, even in immnuocompromised persons; facial paresis is reported in zoster oticus in immunocompetent patients; – viral culture is the golden diagnostic standard; PCR detects VZV-DNA in fluids and tissues in some difficult cases; – direct immunfluorescence assay with labeled VZV-specific monoclonal antibodies is rare recommended in practice, where we prefer Tzanck-test; Tzanck test is simple, not expensive, easy to perform, but unable to distinguish between VZV and HSV (herpes simplex virus) infection; – extremely rare we perform skin biopsy to confirm diagnosis, even in zoster oticus; – regarding the treatment we prescribe also Brivudin 125mg/ day 7 days to limit acute symptoms, to prevent PHN and complications of herpes.
 
– sharks
 
– fish
 
– amphibians
– dinosaurs
– reptiles
– snakes
– amphibians
– birds
– mammals
Ancestral
primates
Hominids
Homo erectus
Homo sapiens
400 milion
years ago
100-70 milion
years ago
70-50 milion
years ago
6 milion
years ago
 
 

 

REFERENCES
1. Mc Geoch DJ, Gatherer D: Integrating reptilian herpesvirus into the family herpesviridae. J Virol. 2005;79:725-31.
2. Grose Ch: Varicelo-zosterian virus –out of africa and into the research laboratory. Herpes 2006;13:32-3.
3. Ozel L, Toros SZ, Unal E, Kara M, Eren PA, Canbakan M, et al: Ramsay Hunt syndrome with atypical progress in a renal transplant recipient: a case report. Exp Clin Transplant. 2011;9:413-6.


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