Shoji Kawano

Detection of varicella-zoster virus DNA in peripheral mononuclear cells from patients with Ramsay Hunt syndrome or zoster sine herpete.

On the basis of alterations in varicella‐zoster virus (VZV) antibody titers, it appears that Bells palsy in some patients could be associated with VZV reactivation, that is, zoster sine herpete. To obtain stronger evidence of this association, polymerase chain reaction (PCR) was used to detect VZV DNA in auricular lesions or peripheral blood mononuclear cells (PBMCs) from Bells palsy or Ramsay Hunt syndrome patients. VZV DNA was detected in the auricular lesions of Ramsay Hunt syndrome, in PBMCs from 2 Ramsay Hunt syndrome patients, and in 4 of 17 samples from 16 Bells palsy patients. Three of these four positive patients were thought to have zoster sine herpete because of hearing difficulty, vertigo, and pain. VZV IgM antibodies were positive in 1 of the 2 patients with Ramsay Hunt syndrome, and in 2 of the 17 samples from the Bells palsy patients. VZV IgG antibody titers during the acute phase were significantly higher in the patients positive for the PCR or VZV IgM antibody than in those negative for them. These findings provide evidence that Bells palsy in some patients could be associated with VZV reactivation. J. Med. Virol. 56:359–363, 1998.

Gastric pneumatosis associated with duodenal stenosis and malrotation

Abstract. Pneumatosis intestinalis, which is linear or cystic gas within the bowel wall, is usually found in premature babies in association with necrotizing enterocolitis. Gastric pneumatosis defined as intramural gas of the stomach is a rare sign during infancy. We report an infant with Downs syndrome and a duodenal web with obvious gastric pneumatosis.

Specific cellular immunity in immunocompetent children with herpes zoster

We investigated whether specific immunity is low in immunocompetent children with zoster. Specific cellular immunity was found to be significantly lower in 13 otherwise normal children with zoster than it was in 8 matched controls by a lymphoproliferative assay. However, there was no significant difference between them with regard to the antibody response. Therefore, even in the immunocompetent children, decreased specific cellular immunity may play an important role in the mechanism of virus reactivation.

Natural Killer Cell Activity in Herpes Zoster in Children without Underlying Disease

We determined natural killer cell (NKC) activity in 10 otherwise normal children with herpes zoster. NKC activity values in children with vs. without varicella-zoster virus specific IgM antibodies and in controls were 28.3 +/- 8.6%, 11.9 +/- 3.6% and 20.2 +/- 3.8% (mean +/- SD), respectively. There were significant differences between the children with and without IgM antibodies during the acute phase (p < 0.005) and between children without IgM antibodies and controls (p = 0.005). NKC values in children with mild vs. moderate morbidity were 11.7 +/- 4.1% and 25.7 +/- 9.9%, respectively (p < 0.05). The morbidity was moderate in all children with IgM antibodies, but in only 2 of the 5 children without IgM antibodies. Children who contracted varicella when a few months old had the highest IgM antibody titers and the highest value of NKC activity. NKC activity was related both to the presence of IgM antibodies and to the morbidity of herpes zoster.

Proliferative Response to Varicella-zoster Virus is Inversely Related to Development of High Levels of Varicella-zoster Virus Specific IgG Antibodies

We examined specific humoral and cellular immunity from varicella-zoster virus (VZV) in 10 pediatricians, 8 healthy immune adults, 2 non-immune adults, and 15 patients with acute lymphocytic leukemia (ALL) in order to investigate the mechanism of resistance to VZV and the booster effect of frequent re-exposure. The responder cell frequency (RCF) against VZV antigen was determined by lymphoproliferative response with limiting dilution. Four of the 10 children with ALL and receiving maintenance therapy did not have VZV-specific cellular immunity according to our positive criteria (Stimulation Index > 2.0 and RCF > 1:150,000), but 3 of these 4 patients had VZV-specific IgG antibody. In both healthy adults and ALL patients re-exposure to VZV or reactivation of the virus enhanced VZV-specific immunity. Individuals with very high RCF values (> 1:10,000) had the lowest IgG antibody titers.

Immunogenicity of the whole antigen and glycoprotein I of varicella-zoster virus (VZV) and the VZV skin test antigen

Specific cellular immunity against the whole antigen and glycoprotein I (gp I) of varicella‐zoster virus (VZV) and the skin test antigen were determined for 13 healthy immune adults to compare the immunogenicity of these antigens using a lymphoproliferative assay. The stimulation index values (mean ± s.d.) were 16.4 ± 11.2 against the whole VZV antigen, 4.2 ± 2.9 against the VZV skin test antigen and 1.1 ±0.5 against gp I. The immunogenicity of the skin test antigen, which mainly contains gp III and gp IV, appears to be more favorable than that of gp I alone, but to be weaker than that of the whole VZV antigen.

Alteration of T cells and natural killer cells during chickenpox in infancy

To determine the reasons for the low immune response and the mild morbidity of chickenpox in infancy, we investigated alteration of T cells and natural killer (NK) cells during chickenpox in children <1 year and ≥2 years old using flow cytometry. The CD4/CD8 ratio decreased only in the <1-year-old group from the acute to the convalescent phase (P<0.05). The CD3−CD16+CD56+ and CD57−CD16+ counts increased in the <1-year-old group, but those in the ≥2-year-old group did not increase from the acute to the convalescent phase. The CD3−CD16+CD56+ counts and the CD57-CD16+ counts and percentage were larger in the <1-year-old group than those in the ≥2-year-old group (P=0.001,P=0.002, andP<0.05) in the convalescent phase. These results seem to indicate that the low immune response in infancy after chickenpox are related to the small number of CD8 in contrast with CD4 and that increased subsets of NK cells during chickenpox may correlate to the mild morbidity of chickenpox in infancy.

Persistently High Antibody Titers and Deficient Specific Cellular Immunity to Varicella‐Zoster Virus in a Retarded Patient after Varicella Infection

We report on a 19 month old female who has been retarded developmentally after a severe varicella infection contracted from her mother 4 months after delivery. Her titer of varicella‐zoster virus (VZV) IgG antibody has been remarkably high for 4 years after the infection. Natural killer activity and the specific cellular immunity to VZV, as tested by delayed type hypersensitivity skin test and lymphocyte‐proliferation assay, were impaired. She had an improvement of ataxia and then progressed developmentally after administration of an anti‐viral agent. Administration of oral corticosteroids and methylprednisolone transiently decreased titers of VZV antibody and, contrary to previous reports, returned natural killer activity to normal levels. We suggest that this case may be a persistent VZV infection similar to congenital cytomegalovirus infection due to selective defects in cellular immunity including NK cells. Whether this specific deficient cellular immunity is genetically determined or secondary to the viral infection is speculative. This is the first known report of such a case.