Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/16690
Title
Mutations in Coding and Non-Coding Regions in Varicella-Zoster Virus Causing Fatal Hemorrhagic Fever Without Rash in an Immunocompetent Patient: Case Report
Author(s)
Camacho, Juan ISCIII | Negredo, Anabel ISCIII | Carrilero, Bartolomé | Segovia, Manuel | Moreno, Antonio | Pozo Sanchez, Francisco ISCIII | Echevarria, Juan Emilio ISCIII | Echevarria, Jose Manuel ISCIII | Sánchez-Seco, María Paz ISCIII | Tarrago Asensio, David ISCIII
Date issued
2023-11
Citation
Infect Dis Ther. 2023 Nov;12(11):2621-2630.
Language
Inglés
Document type
research article
Abstract
Introduction: We report the case of a fatal hemorrhagic varicella primary infection in an immunocompetent man and whole-genome characterization of the virus for the investigation of biomarkers of virulence. Case: A 38-year-old patient born in Nigeria presented to the emergency department with abdominal pain and subsequently developed fatal hemorrhagic disease without skin rash. Extensive laboratory tests including serology and PCR for arenaviruses, bunyaviruses and ebolaviruses were negative. Varicella-zoster virus (VZV) PCR of sera, liver and spleen tissue samples from autopsy revealed the presence of VZV DNA. Primary infection by varicella-zoster virus with hemorrhagic manifestations was diagnosed after virological testing. The VZV genome was sequenced using a mWGS approach. Bioinformatic analysis showed 53 mutations across the genome, 33 of them producing non-synonymous variants affecting up to 14 genes. Some of them, such as ORF11 and ORF 62, encoded for essential functions related to skin or neurotropism. To our knowledge, the mutations reported here have never been described in a VZV causing such a devastating outcome. Discussion: In immunocompetent patients, viral factors should be considered in patients with uncommon symptoms or severe diseases. Some relevant mutations revealed by using whole genome sequencing (WGS) directly from clinical samples may be involved in this case and deserves further investigation. Conclusion: Differential diagnosis of varicella-zoster virus in immunocompetent adults should be considered among patients with suspected VHF, even if the expected vesicular rash is not present at admission and does not arise thereafter. Whole genome sequencing of strains causing uncommon symptoms and/or mortality is needed for epidemiological surveillance and further characterization of putative markers of virulence. Additionally, this report highlights the recommendation for a VZV vaccination policy in non-immunized migrants from developing countries.
Subject
Hemorrhagic fever | Metagenomic whole genome sequencing (mWGS) | Single-nucleotide polymorphism (SNP) | Varicella-zoster virus | Varicella-zoster virus cell tropism | Varicella-zoster virus clades | Varicella-zoster virus mutations | Varicella-zoster virus virulence
Online version
DOI
Collections
Related items
Showing items related by title, author, creator and subject.
-
2019-01
research article
González, Irene; Molina-Ortega, Alejandro; Perez-Romero, Pilar ISCIII; et al. -
2014-09-07
research article
Torres-de Mier, Maria de Viarce ISCIII; Ciaravino, G.; Sagrado, Maria Jose ISCIII; et al. -
2020-05-17
research article
Masa-Calles, Josefa ISCIII; Vila-Cordero, Beatriz; Lopez-Perea, Noemi ISCIII; et al.