Biological Plausibility of a Link Between Arterial Ischemic Stroke and Infection With Varicella-Zoster Virus or Herpes Simplex Virus.

Content Provider	Semantic Scholar
Author	Grose, Charles
Copyright Year	2016
Abstract	There are now 9 human herpesviruses (HHVs); the increase from 8 to 9 was caused by a recent decision to split HHV strains 6A and 6B into distinct species. The 9 species are subdivided into 3 subfamilies: alpha (herpes simplex virus [HSV] types 1 and 2 and varicella-zoster virus [VZV]), beta (cytomegalovirus, HHV6A, HHV6B, and HHV7), and gamma (Epstein-Barr virus and Kaposi sarcoma–associated herpesvirus [sometimes called HHV8]). These same herpesviruses have evolved with humankind around the world since the great migration of modern humans across the Mandeb Strait out of Africa ≈60 to 100 thousand years ago.1 In a report in this issue of Circulation , Elkind et al2 sought to determine whether any of 5 herpesvirus infections—HSV1, HSV2, VZV, cytomegalovirus, or Epstein-Barr virus—increased the risk of arterial ischemic stroke (AIS) in children ≤18 years of age. They conclude that HSV1 infection and, to a lesser extent, VZV infection may act as triggers for childhood AIS. This editorial examines the biological plausibility of that assertion on the basis of both a literature review and the known pathogenesis of infection with HSV, VZV, and the live attenuated varicella vaccine virus. Article, see p 732 VZV is the virus of greatest interest because the data linking VZV to arteritis and stroke are the strongest among all herpesviruses (Figure 1). The largest review of VZV infection and AIS in children includes 70 cases.3 The median age was 5 years (range, 6 months–14 years). Stroke occurred after varicella in 90% and herpes zoster in 10%; in 2 children, stroke followed varicella vaccination. The median interval between varicella or herpes zoster and subsequent stroke was 18 weeks. The most common clinical presentations were hemiparesis, speech disorders, facial palsy, and headache. In the present report, the association of AIS with VZV was not …
Starting Page	392
Ending Page	400
Page Count	9
File Format	PDF HTM / HTML
Alternate Webpage(s)	http://circ.ahajournals.org/content/circulationaha/133/8/695.full.pdf?download=true
PubMed reference number	26813103v1
Alternate Webpage(s)	https://doi.org/10.1161/CIRCULATIONAHA.116.021459
DOI	10.1161/CIRCULATIONAHA.116.021459
Journal	Circulation
Volume Number	133
Issue Number	8
Language	English
Access Restriction	Open
Subject Keyword	Cerebral Infarction Chickenpox Vaccine Editorial Epstein-Barr Virus HIV Infections Herpes Simplex Infections Herpes zoster disease Herpesviridae Infections Herpesvirus 6A, Human Herpesvirus 6B, Human Human herpes simplex virus Human herpesvirus 1 Human herpesvirus 3 Ischemic Cerebrovascular Accident Kaposi Sarcoma Precipitating Factors Simplexvirus
Content Type	Text
Resource Type	Article