LITERATURE UPDATE
Varicella-zoster virus: the childhood infective agent that can reactivate later in life as shingles
While chickenpox is generally regarded as a childhood medical rite of passage, infection by the virus responsible can have serious consequences, particularly for infants, adults, pregnant women, and those with a weakened immune system. Here, Pathology in Practice Science Editor Brian Nation looks at a selection of current research into varicella virus infection.
Varicella-zoster virus-related neurological complications: From infection to immunomodulatory therapies
Hakami MA, Khan FR, Abdulaziz O et al. Rev Med Virol. 2024 Jul;34(4):e2554. doi: 10.1002/rmv.2554.
The varicella-zoster virus (VZV), classified as a neurotropic member of the Herpesviridae family, exhibits a characteristic pathogenicity, predominantly inducing varicella,
commonly known as chickenpox, during the initial infectious phase, and triggering the reactivation of herpes zoster, more commonly recognised as shingles, following its emergence from a latent state.
The pathogenesis of VZV-associated
neuroinflammation involves a complex interplay between viral replication within sensory ganglia and immune-mediated responses that contribute to tissue damage and dysfunction. Upon primary infection, VZV gains access to sensory ganglia, establishing latent infection within neurons. During reactivation, the virus can spread along sensory nerves, triggering a cascade of inflammatory mediators, chemokines, and immune cell infiltration in the affected neural tissues. The role both of adaptive and innate immune reactions, including the
contributions of T and B cells, macrophages, and dendritic cells, in orchestrating the immune-mediated damage in the central nervous system is elucidated. Furthermore, the aberrant activation of the natural
defence mechanism, characterised by the dysregulated production of
Typical chickenpox skin eruptions on a child’s back.
WWW.PATHOLOGYINPRACTICE.COM OCTOBER 2025
immunomodulatory proteins and
chemokines, has been implicated in the pathogenesis of VZV-induced neurological disorders, such as encephalitis, myelitis and vasculopathy. The intricate balance between protective and detrimental immune responses in the context of VZV infection emphasises the necessity for an exhaustive comprehension of the immunopathogenic mechanisms propelling neuroinflammatory processes. Despite the availability of vaccines and antiviral therapies, VZV-related neurological complications remain a significant concern, particularly in immunocompromised individuals and in the elderly. Elucidating these mechanisms might facilitate the emergence of innovative immunomodulatory strategies and targeted therapies aimed at mitigating VZV-induced neuroinflammatory damage and improving clinical outcomes. This comprehensive understanding enhances our grasp of viral pathogenesis and holds promise for pioneering therapeutic strategies designed to mitigate the neurological ramifications of VZV infections.
Varicella: is it time for a global vaccination programme? Wooding EL, Kadambari S, Warris A. Arch Dis Child. 2025 Jul 18;110(8):586-591. doi: 10.1136/archdischild-2024-327593.
Varicella, known as chickenpox, is caused by the varicella zoster virus (VZV), with an estimated 84 million cases annually. It primarily affects children, for most of whom it is a self-limiting illness. However, there are an estimated 950 000 disability- adjusted life years attributed to VZV annually, disproportionately affecting lower-income settings. Children with impaired immunity and neonates are particularly at risk for severe varicella. Epidemiology varies between tropical
51
phil.cdc.gov / Wikimedia Commons
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
