Early detection of Varicella-Zoster Virus (VZV)-specific T-cells before seroconversion in primary varicella infection case report.docVIP

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Early detection of Varicella-Zoster Virus (VZV)-specific T-cells before seroconversion in primary varicella infection case report.doc

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Early detection of Varicella-Zoster Virus (VZV)-specific T-cells before seroconversion in primary varicella infection case report

Baikeretal.VirologyJournal2010,7:54 /content/7/1/54 CASE REPORT OpenAccess EarlydetectionofVaricella-ZosterVirus (VZV)-specificT-cellsbeforeseroconversionin primaryvaricellainfection:casereport ArminBaiker ,RudolfHaase ,JosefEberle ,MariaGuadalupeVizosoPinto ,Klaus-IngmarPfrepper2, 1* 1 1 1 AndreasPetrich,LudwigDeml,HartmutCampe,HansNitschko,GundulaJaeger1 2 3 4 1 Abstract Herewereportthecaseofa54-yearold,immunocompetentGermanpatientwithprimaryvaricellawhoseVari- cella-ZosterVirus(VZV)-specificT-cellresponsescouldbedetectedearlyininfectionandbeforetheonsetofsero- conversion.ThiscasedemonstratesthatthedetectionofVZV-specificT-cellsmayundercertaincircumstances supportthediagnosisofaprimaryvaricellainfection,asforexampleincasesofatypicalorsubclinicalvaricellaor intheabsenceofdetectableVZVDNAinplasma. Background Casepresentation Varicella-Zostervirus(VZV)causesvaricelladuringpri- Wereportthecaseofa54-year-old,immunocompetent maryinfectionandmaycauseherpeszosterafterreacti- German(Caucasian) manwhopresentedwithskinrash vation from latency. Varicella is typically diagnosed by and fever (day 0). Due to the clinical appearance of a characteristicclinicalsignsandusuallydoesnotrequire typical“varicella-like”rashphenotype, antiviral therapy laboratorytesting.Duetotheintroductionofmassvac- with Brivudine wasinitiated atthedayofthepatient’s cinationprogrammes,however,theincidence oftypical presentationandrashonset.Serologicalanalysisofblood varicellahasdeclined.Thisdeclinehasledtoareduced takenatday0exhibitednoVZV-specificantibodiesindi- experienceofphysiciansindiagnosingvaricella.Further- cativeforapast(VZV-IgG)orprimary(VZV-IgM)VZV more,anincreasedincidenceofatypicalandvaccination infection. Inorder toconfirm thesuspicion ofprimary breakthrough varicella infections has been described varicella,asecondbloodsamplewastakenatday2post [1-4].Fortheearlydiagnosisofcaseswithsevereoraty- rashonset(p.r.o.).Again,subsequentserol