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Expression of concern regarding paper by Park et al, published on 25 June 2015: “Epidemiological investigation of MERS-CoV spread in a single hospital in South Korea, May to June 2015”, Euro Surveill.
It has been brought to our attention that some of the authors may not have been informed about the content of the above paper.
Citation style for this article: Sauerbrei A, Schmitt S, Scheper T, Brandstadt A, Saschenbrecker S, Motz M, Soutschek E, Wutzler P. The prevalence of herpes simplex virus (HSV) type-specific IgG was determined in sera taken in 1999 to 2006 from 1,100 children aged 0–18 years, 800 blood donors and 200 pregnant women in Thuringia, Germany, using tests based on the HSV glycoproteins (g) gG. Herpes simplex virus (HSV) is one of the most common pathogens affecting humans: it can remain latent lifelong in sensory ganglia and can be reactivated periodically. Excretion of the virus from herpetic lesions (mainly lips and genitals) in symptomatic people with recurrent infections and excretion of the virus in the saliva and genitals of asymptomatic people are regarded as the most important source of the virus [2]. Unlike HSV-1, HSV-2 is predominantly acquired through sexual activity [3] and causes the great majority of genital herpes [4]. HSV type-specific seroprevalence has been extensively studied in many countries all over the world.
The envelope glycoproteins (g) G of HSV-1 (gG-1) and HSV-2 (gG-2) are known to be type-specific antigens [14] and have been used in nearly all conclusive HSV-1 and HSV-2 seroprevalence studies [3].
As there are few data on the prevalence of HSV antibodies in Germany, we carried out a seroepidemiological study to determine the HSV-1 and HSV-2 antibody prevalence in children, adults and pregnant women in the German federal state of Thuringia. In this study, 1,100 sera from infants, children and adolescents aged 0 to 18 years, (hereafter referred to as children aged 0 to 18 years), 800 sera from blood donors aged 19 to 30 years and 200 pregnant women aged between 17 and 40 years were included. For the blood donors and pregnant women, informed oral consent for use of their sera was obtained. Samples from those aged 18 years or under lived in Erfurt, the capital of Thuringia, and its rural surroundings.
Serum samples from the pregnant women were taken from those who delivered at their local district hospital (in Thuringia) between January 1999 and January 2000.
Sera were stored in aliquots at –20 °C without interruption until tested for antibodies to HSV-1 and HSV-2. All samples with discordant results in the gG-1 and gC-1 ELISAs were retested twice and the most frequent result (including the original test result) was accepted.
A sample size of about 150 subjects per pre-specified age group was planned to assure that a two-sided 95% confidence interval (CI) for the prevalence of HSV antibodies would extend at most 8% from the observed value for a prevalence range of 5–95%. Antibody prevalence was calculated using the number of seropositive cases divided by the number of all subjects tested. The amount of agreement between gG-1 and gC-1 ELISAs was computed using the number of sera with concordant results divided by the number of sera tested. Data on the prevalence of IgG antibodies against HSV-1 in the samples tested are shown in Table 1.
The Figure shows the age- and sex-specific prevalence of HSV-1 IgG in the children and adults (blood donors) tested.
Of the 2,100 sera tested in this study, 71 showed equivocal results in either of the HSV-1 ELISAs after having been repeated twice and were excluded from the comparison of both ELISAs. Of the 32 sera that gave equivocal results in the HSV-2 gG ELISA, after having been repeated twice, 28 were negative by immunoblot assay (Table 3). After retesting of sera that were positive in the HSV-2 gG-2 ELISA (n=201), 191 (95%) were also positive in the HSV-2 immunoblot.
Seroprevalence studies of HSV-1 and HSV-2 are vital for a better understanding of the public health importance of disease due to HSV. As expected, the prevalence of antibodies against HSV-1 and HSV-2 was significantly lower in children and adolescents than in adults; however, for HSV-1, this concerned children only up to the age of 15 years. A considerable delay of HSV-1 infection during childhood has been reported from Finland, where only 17% of children at the age of eight years had antibodies to HSV-1 [21].
In our study, adults (blood donors) aged between 19 and 30 years had an HSV-2 seroprevalence of 13.6%. Our finding of a higher seroprevalence of HSV-2 among women than among men is in agreement with several other studies [10,30,31]. Disclaimer: The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Sir,65-year-old male, known case of non-hodgkin lymphoma completed four cycles of chemotherapy (CHOP) two months back, presented with generalized vesicular eruption and constitutional symptoms of five days. For the quantitative determination of IGM Antibodies to Herpes Simplex Virus Type 1 (HSV-1) in serum. The infection with this virus is very common but, in healthy people does not produce disease.
Is a member of the herpesviridae family together with herpes simplex, Epstein-Barr, varicella-zoster viruses. Presence of "cytomegalic" cells with reddish-blue intranuclear inclusions surrounded by a clear halo to impart a peculiar owl's eye appearance, hepatocytes, bile duct epithelium, endothelial and connective tissue cells. In cases of congenital hepatitis the picture is that of a severe "neonatal hepatitis" with necrosis and formation of multinucleated giant cell without significant inflammatory cell reaction.
In cases of cytomegalovirus mononucleosis, which are rare, the liver shows a prominent diffuse lobular inflammation with lymphocytes, plasma cells and macrophages without significant necrosis.
The "gold standard" for diagnosis of CMV is the conventional cell culture based on the appearance of the typical cytopathic effect (CPE) in the infected cells. Notice an area of necrosis with nuclear inclusions in hepatocytes and not much inflammatory reaction. This virus produces infectious mononucleosis in young adults throughout the world and seems to contribute to Burkitt's lymphoma and nasopharyngeal carcinoma.
Mononucleosis hepatitis is characterized by peculiar necroinflammatory changes which, at the difference of classical viral hepatitides consist of more inflammation and less necrosis. Another peculiar feature is the presence of a marked regenerative activity of hepatocytes with presence of increased number of binucleate cells, polyploid nuclei and mitotic figures. High power of previous illustration showing the signs of high regenerative activity: binucleate cells and a mitotic figure.
Seroprevalence of herpes simplex virus type 1 and type 2 in Thuringia, Germany, 1999 to 2006. In persons with past primary HSV-1 infection, the risk of acquiring HSV-2 is probably reduced since most antibodies cross-react between HSV-1 and HSV-2 [5]. Seroprevalence rates of HSV-1 of between 50% and 85% or more have been shown in adults from developed countries, such as Germany, Spain and Norway, in the last two decades [3,10]. Recently, gC-1 was shown to be an equivalent antigenic target for type-specific diagnosis of HSV-1 infections [15].
For detection of HSV-1-specific antibodies, results from two enzyme-linked immunosorbent assays (ELISAs) based on the detection of gG-1 or gC-1 were compared for 2,100 serum samples collected during 1999 to 2006. These samples had been taken for routine serological tests, for example, medical check-ups or determination of immune status, during 1999 to 2006.
Those that still gave equivocal results after retesting were analysed using immunoblot recomLine HSV-1 & HSV-2 IgG, as were all sera that were positive, to avoid false-positive results, as results from other studies suggests that HSV-2 ELISAs may results in false-positive results [17]. Adjusted for age, the prevalence of HSV-1 antibodies among girls aged between 0 and 18 years was significantly lower than among boys of the same age (p=0.039).
Adjusted for age, a significantly higher prevalence of HSV-2 IgG in women than in men was detected (p=0.021).
In this study, we were particularly interested in determining the HSV seroprevalence of children up to the age of 18 years, since there is little known about this.
After the disappearance of maternal antibodies in the first year of life, there was an increase in HSV-1 IgG prevalence to 20% by the age of 2–3 years, to 40% by 4–6 years, to almost 60% by 10–12 years, to 70% by 16–18 years and to about 80% by the age of 28–30 years. Surprisingly, the prevalence of HSV-1 antibodies among girls was lower than among boys in our study. In those aged 16–18 years, the prevalence increased to 7.3%, indicating a rising incidence of primary HSV-2 infections, probably due to the start of sexual activity. There was a significantly higher prevalence of HSV-2-specific antibodies among women (16%) than among men (11%) and in pregnant women, the prevalence was 18%.
This may result from the differential role of sex on clinical presentation since men appear to have a higher tendency of asymptomatic HSV-2 infection [30].
A recent study revealed that gC-1 and gG-1 may be comparable antigenic targets for the serodiagnosis of HSV-1 infections [15]. Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review.
Genital herpes simplex virus type 1 in women: detection in cervicovaginal specimens from gynecological practices in the United States. Common use of inaccurate antibody assays to identify infection status with herpes simplex virus type 2. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy.
Herpes simplex virus: incidence of neonatal herpes simplex virus, maternal screening, management during pregnancy, and HIV. Seroprevalence of herpes simplex virus type 1 and type 2 in selected German populations-relevance for the incidence of genital herpes. Early acquisition of herpes simplex virus type 1 antibodies in children–a longitudinal serological study. Antigenic differences between HSV-1 and HSV-2 glycoproteins and their importance for type-specific serology. The glycoproteins C and G are equivalent target antigens for the determination of herpes simplex virus type 1-specific antibodies. Die (Weiter-) Verwendung von menschlichen Korpermaterialien fur Zwecke der medizinischen Forschung (2003) [The (further) use of human body samples for the purpose of medical research (2003) English translation of the title].
Prevalence of herpes simplex virus types 1 and 2 among children and adolescents attending a sexual abuse clinic.

Development of antibodies against cytomegalovirus, varicella-zoster virus and herpes simplex virus in Finland during the first eight years of life: a prospective study.
National seroprevalence and trends in herpes simplex virus type 1 in the United States, 1976-1994.
Prevalence of antibodies against herpes simplex virus types 1 and 2 in children and young people in an urban region in Tanzania. Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention. Seroprevalence study of herpes simplex virus type 2 among pregnant women in Germany using a type-specific enzyme immunoassay. The burden of infection with HSV-1 and HSV-2 in England and Wales: implications for the changing epidemiology of genital herpes. Premarket evaluation of a commercial glycoprotein G-based enzyme immunoassay for herpes simplex virus type-specific antibodies. Comparison of four enzyme immunoassays with a western blot assay for the determination of type-specific antibodies to herpes simplex virus. Novel recombinant ELISA assays for determination of type-specific IgG antibodies against HSV-1 and HSV-2. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal. Co-reactivation of varicella zoster virus and herpes simplex virus with disseminated cutaneous lesions in a lymphoma patient. Disseminated herpes Simplex virus and varicella zoster virus coinfection in a patient taking thalidomide for relapsed multiple myeloma. Simultaneous reactivation of herpes simplex virus and varicella-zoster virus in a patient with idiopathic thrombocytopenic purpura. Concurrent reactivation of varicella zoster virus and herpes simplex virus in an immunocompetent child. Identification and characterization of 20 immunocompetent patients with simultaneous varicella zoster and herpes simplex virus infection. Herpes simplex virus (HSV) types 1 and 2 are members of the Herpesviridae family, and produce infections that may range from mild stomatitis to disseminated and fatal disease. HSV-1 is generally spread by kissing or by sharing eating utensils (such as spoons or forks) when sores are present. The new tests for herpes, called type-specific serologic tests, distinguish between HSV-2 and HSV-1, the other type of herpes simplex virus.
The viral particles consist of a DNA core, a icosahedral capsid, adn a surrounding envelop. The infection acquired in the may present a serious illness which begins shortly after birth with jaundice, purpura, hemolytic anemia, thrmobocytopenia, brain damage, microcephaly and paravetricular calcifications. The infection may produce a chronic disease with abnormal liver function tests and recurrent fever and jaundice. However, an average of 7-10 days is required for the CPA to develop, which in a critically ill patient is too long. This consists in the incubation of the tissue on a glass slide with antibodies to the virus. Unfortunately, the ubiquitous presence of the virus and the common asymptomatic type infection makes the evaluation of a single measurement of antibody level difficult to interpret.
Their accuracy, when compared with culture or histologic methods, is still being evaluated.
Type 1 produces herpes simplex infection especially recurrent blisters around the lips and generalized infections in older children and adults.
The infection in childhood is common and asymptomatic but it may rarely cause mononucleosis syndrome. There is marked mononuclear cell infiltration of sinusoids and portal fields contrasting with mild hepatocellular necrosis.
There are two types, HSV-1 and HSV-2, which differ not only genetically but also in the principal route of transmission, the body site predominantly affected, seroprevalence and rate of reactivation [1]. Although no clinical signs can be recognised in many people with HSV-2 infections, as is also the case for HSV-1 infections, asymptomatic people can shed the virus, and thus there is a substantial risk of viral transmission to their sexual partners [6].
For HSV-2, seroprevalence varied as a function of age, sex, number of lifetime sexual partners and socio-economic status [3,10].
For all people whose samples were included, the clinical or laboratory data did not indicate the presence of infectious diseases.
According to the Central Ethical Committee of Germany [16], when residual samples are used for research studies, patient consent is not required in exceptional cases and the effort needed to obtain the consent is not justifiable. A standard curve based on the extinction values of three calibration sera containing 2, 20 or 200 relative units (RU) per mL was used to the calculate results. However, a limitation of the study is that the collection of sera over a seven-year period may mask changes in seroepidemiology. These data add to previous findings from the German population, using a relatively small number of sera from infants, children and adolescents [10].
However, the difference in prevalence between pregnant women and female blood donors was statistically not significant. To our knowledge, the study presented here is the first comprehensive serosurvey that includes both gG-1- and gC-1-based ELISAs. History of vesicular eruption over lips was recorded for over two years with three episodes at intervals of six months, each lasting for 4-5 days.
Furthermore, type specific herpes IgG tests, which are far more accurate than non type-specific tests, can be used to distinguish between HSV-1 and HSV-2. The HSV Type 1-Specific IgG ELISA (Gull Laboratories Inc) is a qualitative and quantitative ELISA intended for the specific detection of HSV-1 IgG antibodies in human serum samples. Question 1: What is the recommended technique to obtain a specimen for herpes simplex virus (HSV) culture?
Under electron microscopy there are herpes-like virions, defective viral particles and spherical particles called dense bodies. The liver presents cholestasis, fatty changes, focal necrosis with cytomegalic cells in hepatocytes and bile ducts.
Some adults and older children may develop "glandular fever", the so-called Cytomegalic Mononucleosis consisting of a febrile illness of 3-6 weeks duration with lymphocytosis, abnormal lymphocytes but negative Paul-Bunnell test and absence of sore throat and lymphadenitis. Positive cases show a strong, dark-brown or red staining (depending on the counterstain) in the nucleus of the cell. Type 2 affects the genital tract and produces disseminated infection of the neonate with severe hepatic involvement. In debilitation, pregnancy, immunosuppression it may produce a disseminated disease which is usually fatal. The sinusoids are filled and distended with mononuclear cells which are large and sometimes clustered to resemble granulomas sometimes similar to sarcoidosis. Portal tracts are healvily infiltrated by mononuclear inflammatory cells but there is mild erosion of the limiting plates.
The prevalence of HSV-1 antibodies among girls was significantly lower than among boys and a significantly higher prevalence of HSV-2 IgG in women than in men was detected. Even though the risk of vertical viral transmission is lower than that for acquiring primary infection, recurrent genital herpes must be regarded as the most common cause of neonatal infections [7]: up to 85% of neonatal herpes infections are caused by HSV-2 [8], which are associated with a poor prognosis [9].
In Germany, the prevalence of HSV-1 IgG antibodies reached levels of more than 90% in adults during 1996 to 1998, whereas about 15% of adults possessed IgG antibodies to HSV-2 [10].
Our findings are in contrast to the study from Davidovici et al., which demonstrated significantly higher HSV-1 seroprevalence in females aged 10–19 years in Israel [22]. The seroprevalence data of HSV-2 in blood donors in this study are comparable with findings from other parts of Germany [10]. Saschenbrecker are employed by the Institute of Experimental Immunology (affiliated to Euroimmun AG), and M. On examination, discrete and grouped vesicles were seen on the face, trunk and upper extremities with relative sparing of lower extremities and acral regions.
Basically, if you test positive for herpes type 1 and negative for 2 that does not mean you don’t have genital herpes. Herpes simplex virus type 1 (HSV-1) is transmitted by close contact, both sexual and nonsexual, and infections are acquired during childhood and adolescence. Answer: Cell culture and polymerase chain reaction (PCR) are the preferred HSV tests for persons with genital ulcers or other mucocutaneous lesions.
Perinatal infection can be contracted in utero, from infected maternal genitalia and from breast milk.
Infected cell may become cytomegalic but since the infection may not produce morphological changes, the absence of large cells and of intranuclear inclusions do not exclude the infection.
Fatality is high but some patients may recover completely or may come out with permanent brain damage. The picture is similar to that of infectious mononucleosis and can be confused with acute viral hepatitis. This assay requires the incubation of the sample submitted with a monoclonal antibody, labeled with a fluorescent tag.
Disseminated herpes infection is commonly seen in immunocompromised patients (vesicular eruptions, encephalitis, esophagitis, keratitis). The liver lesions are similar to those of herpes simplex, necrotizing with viral inclusions in hepatocytes. The difference is attributed to the exposure to a large quantity of viruses by deep kissing.
The sinusoids are swollen adn the liver cell plates, in some areas, may be compressed and atrophic. The reduced incidence of HSV-1 infections during childhood, especially in girls, has to be followed up since a higher number of primary HSV-2 infections may result. In HSV-1 infection, the body above the waist is predominantly affected; in HSV-2, it is mainly below the waist.

Further studies revealed that the prevalence of antibodies to both HSV types has not changed over the last two to three decades in Germany [11].
In keeping with the findings from Israel, our study suggests that HSV-1 infection is being acquired later in life. It should not be forgotten, however, that the low HSV-2 IgG prevalence might also be caused, at least partially, by false-positive test results because of the limited specificity of HSV-2 antibody tests [17]. The considerably lower seroprevalence rate of 8.9% among pregnant women from Stuttgart (Germany) [28] can only be interpreted in the context of the different serological methods used and differences between the populations tested.
Except where otherwise stated, all manuscripts published after 1 January 2016 will be published under the Creative Commons Attribution (CC BY) licence. Question 5: Is routine herpes simplex virus (HSV) screening recommended using immunoglobulin G (IgG) type-specific serology? After a period of incubation of 24 or 48 hours, positive cells display nuclear apple-green fluorescence under the microscope. The virus is a typical member of the Herpesviridae family: DNA core, a icosahedral capsid with 162 capsomers, a surrounding envelope, 120 nm in diameter.
For HSV-1, primary infections occur mostly during infancy and childhood, after maternal antibodies have disappeared in the first year of life. However, only a few studies have analysed the time of HSV seroconversion during infancy, childhood and adolescence. Seroprevalence was calculated only on the basis of the ELISAs using gG-1 and gG-2 and the retest results using an immunoblot assay, where appropriate.
The age- and sex-specific prevalence of HSV-2 IgG in the children and adults (blood donors) tested is shown in the Figure.
This is in contrast to data from the data from the United States, where 68% of the population aged over 12 years had HSV-1 antibodies [23], The overall age-specific HSV seroprevalence rates in childhood obtained from Brazil are 1.5 times higher [24] and the figures from Tanzania are two to three times higher [25] than in this study, from one part of Germany. A review of the literature suggests that the incidence of neonatal diseases caused by both types of HSV ranges widely, from 5 to 31 per 100,000 live births [27]. These factors have also to be considered for the interpretation of data from several countries, where HSV-2 seroprevalence ranged from 4% (in England and Wales) to 24% (in Bulgaria) [29]. You are free to share and adapt the material, but you must give appropriate credit, provide a link to the licence, and indicate if changes were made.
When an IgG antibody binds by the F (ab’) (2) domain to an HSV antigen, the Fc domain of some of the same antibody molecules binds to the FcgammaR, which blocks Fc-mediated functions. My understanding on HSV 1 is that the vast majority of people have it and caught it as children and had the usual cold sore outbreaks. Practically all pirmary infections are asymptomatic but the infected individuals excrete the virus in the urine and saliva for months and years and are infectious. Similar symptoms may appear in the so-called Postperfusion Syndrome which develops after massive transfusions from multiple donors in both positive and negative individuals for anti-CMV antibodies. Groups of hepatocytes surrounding these areas contain intranuclear eosinophilic viral bodies (Cowdry type A inclusions).
It is found in lymphoid tissues and in the epithelium of the nasopharynx and probably of the cervix. Obviously, the sinusoidal infiltration reflects the mononucleosis picture of the peripheral blood.
In particular, little is known about the seroprevalence of HSV-2 in children: seroprevalence in childhood is often used to estimate the incidence of intrauterine and neonatal HSV-2 infections. Relatively high prevalence rates of HSV-2 infection in Tanzanian children suggest that non-sexual transmission of HSV-2 (e.g. Having been infected with HSV1, the immune system has already manufactured, and kept on reserve, antibodies to this virus.
The virus may be reactivated from the latent state by decreased imune response usually induced by disease or drugs especially by immunosuppressant therapy where reactivation of a primary infection and not re-infection appears to be the norm.
Recent studies have shown that nearly one third of children in Sweden [12] have been infected with HSV-1 and there is a gradual development of antibodies throughout childhood [3,12].
Since previous infection with HSV-1 may protect against HSV-2 infection or attenuate the severity of disease, lower antibody prevalence among girls may result in a higher number of primary HSV-2 infections that are mostly localised in the genital tract in sexually active individuals. Large bullous lesions and grouped vesicles in a zosteriform pattern were seen on left upper back over multiple dermatomes (C7, C8, and T1) [Figure 1]a. Herpes simplex type 1, most often associated with oral-facial herpes, and HSV2, the genital variety, are very similar viruses when viewed through a microscope. The white cells of 5% of blood donors contain CMV virus therefore infection by blood transfusion occurs in a large number (60%?) of patients. After infection, the lymphocyte under the influence of the viral genome produce new antigens which are deposited on their surface. In contrast, HSV-2 antibodies have been reported to appear generally after sexual debut [3,13]. Hence, a reduced incidence of HSV-1 infections during childhood and adolescence, especially in girls, has to be followed up in further HSV-1 seroprevalence studies. Human antibodies specific for glycoprotein C (gC1) of herpes simplex virus type 1 (HSV-1) neutralized the virus infectivity and efficiently inhibited attachment. Because of the wide distribution and the asymptomatic occurrence of CMV infection it is crucial to test donors for organ transplantation. T lymphocytes react to these antigens, become blastoid and form the atypical lymphocytes of the peripheral blood seen in these patients who at this piont develop the full symptoms of infectious mononucleosis which, evidently, is immunopathologically mediated.
Based on clinical findings, possibility of disseminated zoster or disseminated herpes simplex infection or co-infection of both at different anatomical sites was considered.
An infected organ under immunosuppressive therapy will reactivate the virus with disastrous consequences.
Some individuals cannot mount this t-lymphocytic reaction will succumb to the primary EVB infection. Planned Parenthood answers your questions about what testing and treatment options are available for this STD. This is the case of those suffering of X-linked lymphoprolipherative disorder, Duncan's syndrome. Uniplex and nested polymerase chain reaction (PCR) for both VZV (Varicella Zoster Virus) and HSV-1 (Herpes Simplex Virus 1) from the vesicular fluid obtained from discrete as well as grouped vesicles over trunk was positive and thus confirmatory of acute co-infection.
The viruses are herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) are two of the eight known viruses which comprise the human herpesvirus family. IgG antibody titres done on parallel specimen of acute sera (obtained on 5 th day of vesicular eruption) and convalescent sera (obtained on 18 th day) showing four-fold rise denoted recent and past infection. A similarly high prevalence of antibodies to HSV-1 exists among persons worldwide, although variability from country to country is seen.
IgM (Immunoglobulin M) antibody titre was not done as PCR confirmed the acute co-infection. Complete blood counts, renal and liver parameters, chest radiograph, ultrasound abdomen and pelvis were found normal. Main Outcome Measures Seroprevalence of HSV-1 and HSV-2 antibodies based on results from type-specific immunodot assays; diagnosis of genital herpes. HSV-1 and HSV-2 share most of their antigenic sequences; therefore, most herpes antibodies are type-common. In 2% to 10% of immunocompromised patients with zoster, disseminated cutaneous disease occurs. A number of companies offer tests that are based on relative reactivity of serum antibodies to crude preparations of HSV-1 versus HSV-2 antigens. In an immunosuppressed host severe, extensive, widespread eruption of vesicles, pustules and erosions can occur. Disseminated herpes simplex virus infections may resemble varicella; however, there is often an obvious concentration of lesions at and surrounding the site of the primary or recurrent infection and there may be associated pneumonia, hepatitis and encephalitis. Clinically, the widespread infection lesions at varying stages in few areas on the back, sparing of distal areas seemed suggestive of varicella in an immunosuppressed patient, in whom reinfection is possible. Grouped lesions on the face and upper back, unlikely to be seen in varicella aroused suspicion of disseminated zoster or herpes simplex.
Since the zosteriform lesion over the back satisfied the criteria of disseminated herpes zoster which is defined as more than 20 vesicles outside the area of primary or adjacent dermatomes producing a varicella-like eruption, [2] clinically the diagnosis of disseminated zoster was made. Disseminated herpes simplex was also considered as an alternative diagnosis based on the grouped lesions preferentially involving perioral and nasal area, not in a zosteriform pattern.
Usually disseminated herpes simplex in an immunosuppressed host presents with systemic involvement, our patient was stable with no systemic complications.The lesions of varicella, herpes zoster and herpes simplex are indistinguishable by Tzanck smear or histopathology. Detection of viral DNA in clinical specimens after amplifications by PCR provides the greatest assay sensitivity, very high specificity, and rapid turn-around time. A four-fold rise in IgG antibody titres in the convalescent sera was also seen, for both VZV and HSV-1.
Past history of chicken pox and labial vesiculation suggested reactivation of dormant viruses. A final diagnosis of co-reactivation of disseminated zoster and disseminated herpes simplex infection was made.
In our case, coinfection with VZV and HSV-1 presented with lesser morbidity and severity and responded readily to treatment with no recurrence even after 6 months of follow up.
Development of varicella in the intern 10 days post-exposure indicates high infectivity of disseminated zoster as compared to that of zoster.
VZV can also be transmitted through an air-borne route, particularly in patients with disseminated zoster increasing the secondary attack rate manifold.As far as known, around 30 cases of similar co-infection occurring in immunosuppressed as well as immunocompetent patients have been reported worldwide.
Another probable explanation is that reactivation of a neurotropic herpes virus can reactivate another neurotropic virus if both types are present in the same ganglion.

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  • tolik, 29.11.2015 at 14:53:51
    When I feel protecting it on the sores for however it could possibly reactivate.
  • JEALOUS_GIRL, 29.11.2015 at 11:30:50
    However in less than an hour the.
  • Hellboy, 29.11.2015 at 11:26:54
    The result of HSV 1, and that they can.
  • AKROBAT, 29.11.2015 at 10:40:15
    And are due to this fact totally unaware that they've t-cells, referred to as CD8αα+ T-cells, reveal.