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VARICELLA ZOSTER VIRUS- DIAGNOSTICS & TREATMENT

Varicella Zoster Virus

What is Varicella Zoster Virus?

Varicella Zoster virus is a human organism that causes chickenpox (primary infection) and when reactivated it causes shingles in individuals who have low and compressed immunity. When it’s in the initial stage, this virus remained latent in the neurons of CNS and has dormancy in the neurons in all regions of CNS.

This mostly occurs in children of rural areas where they are not being vaccinated and hygiene is not maintained. The most common symptoms of this virus are the red spots or rashes all over the body, high fever, headache, and loss of hunger.

Varicella Zoster Molecular Mechanism:

By consisting of a double-stranded DNA and 12500, 00 base pairs with 68 ORF, this virus infects only human host and not of animal. During its primary infection stage, the virus enters the cell, its effects, and poisons the T cells which is carried into the bloodstream.

Then while delivering the cells to the membrane, they infect different regions of the body as well. While delivering, these particles fuse with the membrane and then packaged in the Golgi region as they are the glycoprotein.

Then these merged particles are transported to the cell surface where they cause primary infection.

Reactivation Stage:

Being in the dormant stage in the neurons of the CNS, the virus reactivates by the triggering of some external factors. With the reactivation in neurons of the CNS, the virus reproduces and infects the already diseased T cells and injects its DNA into the nucleus. It reproduces and spread across the body and causes Herpes Zoster, shingles.

Diagnosis of Varicella-Zoster Virus Infection:

Diagnosis of any infection is an important step towards identifying and examining and disease through which on-time medications can be provided and prevent it from getting worse. In this section, two diagnoses are being discussed which states how the diagnosis procedures have been improved from conventional to advance techniques.

Conventional Methods of Diagnosis

This section describes the conventional methods used in the diagnosis for Varicella Zoster Virus infection and for Herpes Zoster as well, which were discontinued due to various reasons or more advanced techniques were developed which were more efficient and reliable.

Tznack Smear Test:

In this test, the structural examination is carried out of VZV by taking the sample from the rash part or blisters and then stained with different dyes which helps in diagnosing the virus under a light microscope. It was used for its low cost but is discontinued due to its low sensitivity.

Viral Culture:

Samples are collected from different parts of the cell were virus is likely to infect, stored at 4C and then delivered into the culture via viral delivered media. This shows results within 2 weeks and was a time taking procedure which was discontinued due to reducing sensitivity and mishandling of the samples.

Serological tests:

These tests were carried out to examine the immune activity of the virus. Now, these tests are not used because they are unable to differentiate between primary and secondary infections. Moreover, cross-reactivity of the cells was seen between the viruses.

Nucleic Acid Amplification Approaches:

PCR and enzyme interceded in-vitro methods were applied which detects the DNA of both the viruses. The multiplex PCR proved to be beneficial for nucleic acid diagnosis of these viruses. With many advantages, these are still practiced but its use is limited because of contamination of the organisms during the examination and has low capacity.

Advanced Methods of Diagnosis:

Diagnosis of VZV and HV from skin surface: 

In this diagnosis method, nucleic acids are not examined instead through swabs samples are taken from the infected patients and then real-time PCR and Sonala assay methods are run on them. Sonala assay is the isothermal amplification tests that help in classifying the three types of viruses from this family which helps in analyzing the infection.

These tests do not require nucleic acid extractions and run on extremely high vortex which separates the particles. The samples are often heated and run on different arrays for about 1 to 2 hours for obtaining proper results. Different kits are also used while performing the diagnosis for more efficient results.

This method is sensitive, less time consuming, and provides reliable results. Real-time PCR is applicable for the VZV and Sonala assay is applicable for Herpes Virus [4].

Detection of Viruses by Cerebrospinal Fluid:

The virus detection can be done more rapidly through advanced method which is by cerebrospinal fluid- advanced fragment examination. This technique is a multi-complex one that allows us to classify and examine the gene expressions of such viruses.

It is a combination of multiplex PCR and electrophoresis (capillary) which helps in analyzing several genes in a tube. The fluid was used about 350 ug for the abstraction of DNA and RNA of these viruses and then PCR was run to get the fragments of the viruses.

Then for the electrophoresis markers were used in this procedure. The fragments produced were extracted by the electrophoresis (capillary action) by using different markers.

Figure 1.0 demonstrates that by using HI-DI size markers, the size of each fragment is identified in the electrophoresis with samples that help in the diagnosis of the viruses.

These methods are helpful in diagnosing of the viruses and infection when only mild symptoms occur such as nausea, slight rash, etc. These methods are faster, low cost, and sensitive and produced reliable results. The key characteristic of this method is that it can classify multiple strains of viruses in one go.

Moreover, the required amount of CF fluid and nucleic acid is used which prevents the extraction of access material. These techniques can also be applied for the ones which have a low amount of nucleic acids [5]

Therapies for infection:

This section describes both the conventional therapies and advanced therapies that were and are using to treat the infection caused by the virus.

Conventional Therapies:

Antiviral Drugs:

  1. Acyclovir and Valacyclovir: Both of these drugs are given due to antiviral activity in patients with these viruses. The drugs are often given in combination but possess great side effects when given orally such as on CNS, kidney, and on GI as well, produces toxicity.
  2. Famciclovir: The medication is given in patients with shingles affected with HV. These are also given orally but are not recommended for a small age group. They cause mental disability, nausea, and severe head pain.
  3. Brivudin: It is an antiviral medicine that is used to treat Herpes Virus but is not recommended for small age children. Given orally, they affect enzymes of most of the organs, affect kidney function, and may contrary to the blood count.

These conventional methods for treatment were DISCONTINUED or their use was limited because of the side effects due to which the following advanced therapies were developed.

Advanced Therapies:

  1. Development of Vaccine: For these viruses, live tempered vaccines are being produced which helps in the treatment of these infections, especially in children with compressed immunity. These vaccines are safe to be directed in children which reduces the maximum of the side effects caused by the drugs. Moreover, it helps in minimizing the chance of occurring infections. These vaccines with modification helps in increasing the immunity of the body which helps in fighting with the infections. Once you get vaccinated, there will be less or no chance in the development of such infections. For elderly, vaccine named Shingrix is developed for the elder people which helps in increasing both kinds of immunity against the viruses which eliminates its chances of occurring. This vaccine is given prior to two days and the required level. Serious side effects are not recorded yet.
  2. Lotions and Medications: Many lotions and medications are being developed for reducing the major of the infections. Lotions such as Calamine with cold water is spread gently all over the surface of the body were rashes has been occurred. For reducing pain, Tynelol is being developed which reduces the pain caused by many sores that appeared in mouth and on the body. This avoids taking other medications such as aspirin which makes a person more ill. Moreover, conservative therapies are developed which uses NASIDS medication to reduce pain and prevent the infection from spreading in the secondary stage of infection [8].

These are the advanced therapies used for the prevention and treatment of infections. Other which include are the home remedies advice by the doctors such as taking a cold bath with lotions and oatmeals which prevent the itching of the rashes. Pruning of nails while having these infections to prevent the spread of infection in other parts of the body. Moreover, light intake of food is suggested in these infections.

 

Conclusion- Varicella Zoster Virus: 

Varicella-Zoster Virus and its reactivation can infect humans to a greater extent, if not treated it can be fatal as well. This review covers all the conventional and advanced methods of diagnostics and treatments which will help researchers to explore more insights in this regard.

Some of the conventional methods were discontinued because of their worst side effects and new methods for diagnosis and treatments replaced them which were more efficient and reliable.

In this regard, several other treatments and diagnostics methods are in process which in the future will help in classifying this virus more rapidly and will speed up the treatment process.

 

References:

  1. Kennedy PG, Gershon AA. Clinical features of varicella-zoster virus infection. Viruses. 2018 Nov;10(11):609.
  2. Depledge DP, Sadaoka T, Ouwendijk WJ. Molecular aspects of varicella-zoster virus latency. Viruses. 2018 Jul;10(7):349.
  3. Fan F, Day S, Lu X, Tang YW. Laboratory diagnosis of HSV and varicella-zoster virus infections. Future Virology. 2014 Aug;9(8):721-31.
  4. Jevšnik M, Lusa L, Uršič T, Biškup UG, Petrovec M. Detection of herpes simplex and varicella-zoster virus from skin lesions: comparison of RT-PCR and isothermal amplification for rapid identification. Diagnostic Microbiology and Infectious Disease. 2020 Feb 8:115015.
  5. Song YX, Li Y, Jiang YM, Liu T. Detection of varicella-zoster virus from cerebrospinal fluid using advanced fragment analysis in a child with encephalitis: a case report. BMC infectious diseases. 2019 Dec;19(1):342.
  6. Sauerbrei A. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. European Journal of Clinical Microbiology & Infectious Diseases. 2016 May 1;35(5):723-34.
  7. Kennedy PG, Gershon AA. Clinical features of varicella-zoster virus infection. Viruses. 2018 Nov;10(11):609.
  8. medscape.com/article/1132465-treatment (Accessed on 30th April 2020)

 

 

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    VARICELLA ZOSTER VIRUS- DIAGNOSTICS & TREATMENT – The Jedi Mind Trick
    June 9, 2020 at 1:14 am

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