Indonesian Journal of Biomedicine and Clinical Sciences

Current topics in human varicella infection: Pearls and challenges

Luthvia Annisa — 2024-10-14

Varicella zoster virus (VZV), an alphaherpesvirus, is a highly contagious and neurotropic virus infecting the majority of the adult and pediatric population worldwide. Varicella zoster virus is the only human herpesvirus for which a licensed live attenuated vaccine has been developed. It can be considered that additional study on VZV is superfluous given the significant success of the VZV vaccines. This has been the case for other viruses including rubella and measles, for which effective vaccinations are widely available. Contrarily, much regarding VZV, a complex and chronic human disease due to its latency, still needs to be uncovered. Over the past two decades, our understanding of the molecular biology of VZV and its pathogenicity has expanded. In this review, we discussed our recent understanding of VZV biology, pathogenesis as well as its clinical aspect, including diagnosis, clinical management, and vaccine development.

Neuro-ophthalmologic manifestations of COVID-19: a review

Indra Tri Mahayana — 2024-10-14

Several mechanisms for the pathogenesis of COVID-19 have been proposed. These are direct viral toxicity, endothelial cell damage and thromboinflammation, dysregulated immune response, and renin-angiotensin-aldosterone system (RAAS) dysregulation. The ophthalmic manifestations of COVID-19 vary, affecting the anterior, posterior, and neuro-ophthalmic components. However, the relationship between COVID-19 and neuro-ophthalmologic presentations is limited. This literature review focuses on discussing these manifestations. A manual search was performed using the following keywords “neuro-ophthalmology”, “ocular”, “manifestations”, COVID-19, and coronavirus. The searches were conducted in PubMed and Google Scholar, where any study type and online publications were included. The most common ocular manifestation found in COVID-19 patients is conjunctival involvement. Some reported neuro-ophthalmic manifestations of COVID-19 are papillophlebitis, optic neuritis, cranial nerve palsies, Miller Fisher syndrome, Tolosa-Hunt syndrome, Adie’s tonic pupil, and internuclear ophthalmoplegia. A physician should examine the presence of diplopia, pain during eye movement, declining vision, or any other neurological symptoms. Therefore, it is essential to perform a comprehensive eye examination which includes visual acuity, pupillary response, ocular motility, ptosis, and optic disc examination. Additional tests such as neuroimaging or angiography might be performed to detect cerebral infarction or any other abnormalities when necessary. It is vital to be vigilant and consider COVID-19 as one of the possible causes of disease during this pandemic.

Toxoplasma encephalitis in HIV/AIDS patients in Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Indonesia

Anak Agung Ayu Suryapraba — 2024-10-15

Toxoplasma gondii, an opportunistic infection in HIV/AIDS patients, is an obligate intracellular parasite that causes toxoplasma encephalitis (TE). The symptoms of TE range from subacute focal or global neurologic impairments to neuropsychiatric disorder, and infectious mass lesions. In clinical practice, presumptive diagnosis, including clinical syndrome, finding single or multiple brain lesions on neuroimaging evaluation are preferred. This study aimed to identify neurologic and radiologic characteristics of HIV/AIDS patients with TE in Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Bali. It was a retrospective study using medical records of patients with TE from January 2018 to December 2021. Of 122 subjects, 66.4% were male and 33.6% were female, age ranged from 19-59 y.o. with a median of age 33 y.o., and the CD4 count median was 29.5 cell/mm3. Decreased consciousness was the most prevalent clinical symptom in 40.2% of subjects followed by headache in 18.9% of subjects. A structural lesion in neuroimaging was primarily found in the basal ganglia area of the brain (44.3%). The fatality rate (30.3%) was significantly associated with decreased consciousness, higher leukocyte levels, and a higher neutrophil-to-lymphocyte ratio (p<0.05). Diagnosis of TE should be considered in immunocompromised young adults with subacute onset of focal and/or global neurological deficit and neuroimaging results showing hypodense lesion, particularly with ring-like enhancement, in the
basal ganglia and corticomedullary junction area of the brain. An altered state of consciousness and NLR can indicate poor outcomes in HIV/AIDS patients with TE.