{"id":11018,"date":"2017-07-12T13:42:29","date_gmt":"2017-07-12T19:42:29","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=11018"},"modified":"2025-01-07T12:04:22","modified_gmt":"2025-01-07T19:04:22","slug":"chicken-pox-shingles-varicella-zoster-whatever-you-call-it-cu-team-know-it-best","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/chicken-pox-shingles-varicella-zoster-whatever-you-call-it-cu-team-know-it-best\/","title":{"rendered":"Chicken pox, shingles, varicella, zoster \u2013 whatever you call it, patients benefit from VZV research"},"content":{"rendered":"
<\/div>
\"Hope
Hope Hartman with husband, Mike, and daughters Kate, left, and Lucy. Hope had VZV, which then caused other health problems. Research helps bring awareness to these issues.<\/figcaption><\/figure>\n

You\u2019ve probably heard that childhood chicken pox can re-emerge as shingles as an adult \u2013 in about one-third of all adults, in fact, and as many as half of those who live to be 85.<\/p>\n

That’s because they are both caused by varicella-zoster virus (VZV). When a person is first infected with VZV, it causes chickenpox. After the chickenpox infection resolves, the virus remains dormant in the body’s nerve cells and can then re-emerge as shingles.<\/p>\n

You\u2019ve probably not heard that this same varicella-zoster virus can directly cause stroke and heart attack<\/a>, cognitive impairment, burning mouth syndrome, vision loss, bowel and bladder dysfunction, irregular heartbeat and a growing list<\/a> of other problems \u2013 often with no hint of the excruciating zoster rash (aka singles).<\/p>\n

Hope Hartman was among the unaware until March 2013, when she learned about VZV the hard way.<\/p>\n

Common misconceptions about shingles: Identifying symptoms of VZV accurately<\/strong><\/h2>\n

Hartman was 37, with daughters ages two and four. Like most of us, she had chicken pox as a kid. She had heard of the shingles connection, but, as she put it, \u201cI believed shingles to be something that only affected the elderly \u2013 why would I have shingles?\u201d<\/p>\n

A strange, painful rash took root inside her ear. Her doctor thought it was an infection and prescribed topical antibiotics. They didn\u2019t help. Excruciating pain in the middle of the night sent her to the emergency room at a Denver community hospital.<\/p>\n

At the hospital, doctors were at a loss. She was admitted; she was discharged. She was taken off blood thinners she had been taking for a blood clot in her leg a few months prior. Bell\u2019s palsy<\/a> paralyzed the right side of her face.<\/p>\n

Hartman\u2019s husband, Mike, took an iPhone photo of the rash in her ear and sent it to his mom, a former nurse. \u201cIt looks like zoster,\u201d she replied.<\/p>\n

Mike looked around the web and settled upon something called Ramsay Hunt syndrome<\/a>. It\u2019s cause: VZV. He was right, it turned out. But Hartman was far from out of the woods.<\/p>\n

Varicella-zoster virus research at University of Colorado School of Medicine<\/strong><\/h2>\n

University of Colorado School of Medicine researchers, who have quietly been exposing VZVs secrets since the late 1980s, remain at the vanguard of the still-developing science of understanding and treating VZV.<\/p>\n

Maria Nagel, MD<\/a>, a CU associate professor of neurology and immunology, applies findings from the research lab to the care of a wide range of UCHealth patients.<\/p>\n

\"Maria
Maria Nagel, MD, in her University of Colorado School of Medicine laboratory. Nagel is one of the world’s top clinical reserachers of the varicella-zoster virus that causes chicken pox, shingles and a host of other diseases.<\/figcaption><\/figure>\n

Nagel has studied VZV since VZV research pioneer and then-CU Neurology chair Dr. Donald Gilden, asked her to be a CU neurovirology fellow in 2006 (he had, in 2002, already recruited her to be a CU Neurology resident). Her smarts and affinity for medical research didn\u2019t hurt \u2013 she had been working labs since her undergraduate days at the University of Chicago and through her medical training at the University of Illinois.<\/p>\n

But Gilden surely also recognized in this first-generation Filipino immigrant the sort of person who, years later, in a morning stacked with meetings, invites you in, swivels her office chair in your direction, and focuses her deep well of enthusiasm on explaining the topic of VZV neurovirology in layman\u2019s terms, occasionally reaching over to gently touch the top edge of your laptop screen in empathy. When Gilden died in 2016, Nagel ascended to his role leading CU\u2019s VZV research. She is now recognized as one of the planet\u2019s top clinical VZV experts.<\/p>\n

Fortunately for Hartman, one of her doctors was familiar with Nagel\u2019s work and referred her.<\/p>\n

More than two months had passed since that night in the emergency room by the time Hartman called the Nagel\u2019s office on a Friday. When Nagel got wind of the symptoms \u2013 by that point, Hartman\u2019s eyes were becoming damaged \u2013 she asked that Hartman be at the UCH Neurology Clinic at 8 a.m. on Monday morning.<\/p>\n

Studies on VZV-induced diseases guide treatment plans<\/strong><\/h2>\n

Nagel collaborates with a range of physicians and scientists on the function of a virus that lurks quietly in nerves before emerging in various systems around the body. But her work is primarily done in concert with two PhD research colleagues: Randall Cohrs, PhD, a herpes virus expert (VZV also goes by herpes type 3); and Ravi Mahalingam, PhD<\/a>, who specializes in animal models for the study of VZV. Both worked with Gilden for decades. Building on that foundation, their collaboration with Nagel, Cohrs said, has \u201celevated our research from that of a very, very good group to a world-wide recognized group that can treat people and heal them.\u201d<\/p>\n

Add the research fellows, postdoctoral researchers, graduate and even undergraduate students working in Nagel\u2019s and colleagues\u2019 labs and CU has amassed what she describes as \u201cthe largest group of researchers in the world exploring the clinical manifestations and mechanisms of VZV-induced diseases.\u201d<\/p>\n

\"Randall
Randall Cohrs, PhD, with a printout of the genetic sequence of the varicella-zoster virus he studies. Cohrs is part of a CU School of Medicine Department of Neurology team studying the virus and its many manifestations.<\/figcaption><\/figure>\n

Among their current studies include a continuation of a National Institute on Aging project Gilden launched back in 1988 to study a possible VZV link to giant cell arteritis, also known as temporal arteritis for its tendency to cause inflammation and wincing pain in and around the temples of one\u2019s head.<\/p>\n

Nagel and colleagues have found that fully 70% of patients with the painful condition have VZV viral antigens \u2013 a sign that the body is fighting the virus \u2013 in their inflamed arteries. The implications translate directly to patient care: traditional giant cell arteritis treatment involves suppressing the very immune system that\u2019s fighting the virus.<\/p>\n

\u201cThis can really alter treatment,\u201d Nagel said. \u201cInstead of just immunosuppressive drugs, which can worsen the virus\u2019s impact, they should be treated in addition with an antiviral agent.\u201d<\/p>\n

Once diagnosed with Ramsay Hunt syndrome, Hartman was placed on steroids as well as antivirals. But to Nagel\u2019s eyes on that Monday morning, it was too low of an antiviral dose. Nagel had Hartman admitted to UCH and prescribed intravenous antivirals. She also put her back on blood thinners.<\/p>\n

The rash went away, the eye recovered, and physical therapy at UCH restored almost all the movement on the right side of her face. VZV seemed to have retreated. But it wasn\u2019t finished yet.<\/p>\n

Understanding the connection between VZV and the problems it can cause<\/strong><\/h2>\n

Nagel\u2019s diagnostic skill rests on years of experience both in clinic and doing diverse VZV research. A sampling of hers\u2019 and colleagues current slate: There\u2019s a National Institute of Neurological Disease and Stroke study looking at how the anti-clotting drug clopidogrel (trade name Plavix) may or may not also have antiviral properties with respect to VZV.<\/p>\n

They\u2019re working with CU Skaggs School of Pharmaceutical Sciences professor Tom Anchordoquy to develop nanoparticles capable of delivering molecules that block VZV \u2013 and potentially other \u2013 viral replication while the virus is still in white blood cells early in its life cycle. They\u2019re working with CU Department of Ophthalmology research professor Niklaus Mueller, PhD, on VZV\u2019s persistence in the cornea. They\u2019re even working with NASA.<\/p>\n

As the certificates of appreciation and photos of space shuttle crews on his office wall attest, Cohrs is taking the lead with the space agency. NASA wanted to better understand how the stresses of spaceflight affect dormant viruses such as VZV: you don\u2019t want astronauts battling shingles or other zoster-triggered maladies during an 18-month Mars mission.<\/p>\n

Cohrs analyzed astronaut saliva samples taken before and after shuttle missions and showed that VZV and other herpes viruses indeed reactivated during spaceflight \u2013 one of the astronauts even developed shingles.<\/p>\n

Next up is to work with the U.S. Antarctic Expedition at McMurdo Station, a sort of space-station analog where prior research has shown increased viral shedding.<\/p>\n

While there\u2019s much research to be done, the bottom line with many of the non-skin-related problems associated with VZV appears to be inflammation, Nagel said. She suspects, and the evidence points to, the connection between shingles and strokes\/heart attacks having to do with the virus inflaming arterial walls and causing damage that leads to blockage of the artery or hemorrhage. The same thing is probably happening in the brain, where VZV is implicated in major strokes, as well in as cases of what appear to be dementia that are in fact the result of many mini-strokes slowly starving parts of the brain.<\/p>\n

In Hartman\u2019s case, VZV returned a few months later, announcing its arrival in the form of a splitting sinus headache on the left side. An MRI found a large blood clot \u2013 one that had formed despite Hartman being back on blood thinners. Nagel put her back on intravenous antivirals and upped the blood-thinner dose. Six months later, the same blockage happened on the right side. Nagel discussed the possibilities of surgery with Hartman, but decided that, given the risks, they would keep her on blood thinners and antiviral pills while monitoring her closely. That monitoring, with help from UCHealth hematologist Dr. Kathryn Hassell<\/a>, continues today.<\/p>\n

Hartman marvels that she was lucky enough to have found Nagel, who treats patients from around the world, in her own backyard.<\/p>\n

\u201cShe has saved my life multiple times,\u201d Hartman said. \u201cShe\u2019s a brilliant woman and she spends a lot of time with her patients. She cares a lot. I can\u2019t say enough good things about her.\u201d<\/p>\n

Awareness of VZV is important for<\/strong> accurate diagnoses<\/strong><\/h2>\n

As Hartman\u2019s case showed, the availability of good antiviral drugs means the biggest medical hurdle for many VZV patients is diagnosing it in the first place, Nagel said. The challenge is for doctors and patients to recognize the many manifestations of conditions VZV can cause.<\/p>\n

VZVs life cycle drives that malicious diversity. Once the immune system clears the virus from the bloodstream after the initial chicken pox infection, it hides out in neural ganglia \u2013 bundles of nerves at the intersections of major nervous-system highways. When age-, disease- or stress-weakened immune systems allow, VZV can take those roads to many places, Nagel said: the skin, the brain, the arteries, the heart, the eye, the bladder, even the gut, where VZV in enteric ganglia may be complicit in mysterious abdominal pain, chronic constipation, and ulcers.<\/p>\n

It\u2019s not clear that either the varicella (chicken pox) vaccinations the U.S. Food and Drug Administration approved in 1995 or the zoster (shingles) vaccination it approved in 2006 can stop all these viral manifestations, either, she said.<\/p>\n

From the perspective of improving medical care, Nagel said, \u201cthe first and most important thing is increasing awareness of physicians that VZV can produce multi-system disease.\u201d<\/p>\n

Improvements for VZV treatment comes from continued efforts in research<\/strong><\/h2>\n

To that end, Nagel\u2019s clinical time is spent largely consulting with UCHealth and specialists from as far away as Eastern Europe and Australia about particularly tough cases. Often, she said, patients have seen 20 or so doctors of various specialties before she gets the call. Dr. Richard Davidson,<\/a>\u00a0a CU Ophthalmology professor and practice director for UCHealth Eye Centers<\/a>, described Nagel as \u201ca world expert on VZV.\u201d<\/p>\n

\u201cIt\u2019s a tremendous resource to have her on campus to help care for our patients,\u201d Davidson said in an email. \u201cVZV can be a devastating disease, especially when it affects the eyes. Dr. Nagel\u2019s collaboration has made a significant improvement on our ability to care for these patients.\u201d<\/p>\n

In the long-term, Nagel hopes she and her team can get to the root of what causes the VZV-induced inflammation that then damages tissues and harms patients, she said, ideally through a CU Neurology center focusing on neurovirology. With the U.S. over-65 population \u2013 of whom 95% will harbor VZV \u2013 expected to nearly double to 84 million by midcentury, there\u2019s no time to waste, she said.<\/p>\n

\u201cThis is going to be a significant disease with our aging population,\u201d Nagel said.<\/p>\n","protected":false},"excerpt":{"rendered":"

You\u2019ve probably heard that childhood chicken pox can re-emerge as shingles as an adult \u2013 in about one-third of all adults, in fact, and as many as half of those who live to be 85. That’s because they are both caused by varicella-zoster virus (VZV). When a person is first infected with VZV, it causes […]<\/p>\n","protected":false},"author":23,"featured_media":11027,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[848,4805,1046,162,4097,4781,869,3631,257],"class_list":["post-11018","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-eye-care-ophthalmology","tag-eye-conditions-our-treatments","tag-health-screening","tag-infectious-diseases","tag-preventive-care","tag-research-in-health-care","tag-stroke-care","tag-uchealth-sue-anschutz-rodgers-eye-center","tag-virus-prevention"],"acf":[],"yoast_head":"\nResearch helps treat VZV-induced diseases - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Varicella-zoster virus (VZV) causes chickenpox and shingles, and leads to other problems. 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