VZV在线视频

Welcome back.
欢迎回来

Let’s answer Prof. Li’s questions:
首先来回答李教授的问题

Can this disease be treated?
这种病能治吗？

Yes, we can use acyclovir which
是，可以用阿昔洛韦治疗

is a specific medication for this virus.
本病的常用的治疗药物

Can he recover from
李教授能

the disease completely?
完全康复吗？

Unfortunately,
实际上

none of the currently available drugs
目前没有可用的

can prevent HSV latent infection.
阻止潜伏病毒的药物

Recurrence may also occur.
本病仍可能复发

Can he transmit this disease
本病会传播给

to his young grandson who is 2 years old?
他两岁的小孙子吗？

Yes, the child should not be
会的，小孩子不可以

in contact with the vesicular lesions,
接触水疱

and personal hygiene is also important.
个人卫生也很重要

That is HSV. Now let's move to VZV.
HSV学习完了。现在来学习水痘-带状疱疹病毒（VZV）。

Story 2：Mrs. Zhang's “stripe rash”
第二个故事：张阿姨的“缠腰蛇”

Mrs. Zhang is 50-year-old.
张阿姨50岁

She developed a painful skin rash
她一周前皮肤出现水疱样皮疹

with blisters on one side
出现身体的一侧

of the body a week ago.
很疼

The rash emerged as a linear
皮疹在腰上

stripe pattern on the waist.
呈条带状

There are clusters
有一簇一簇的

of fluid-filled blisters which break easily.
水疱，很容易破

The rash is really painful.
皮疹很疼

So the questions:
那么问题是

What is the disease?
这是什么病？

Why did she become infected?
她为何会被感染？

And how do we treat the patient
我们如何治疗病人

and protect others?
并保护其他人？

Varicella-Zoster virus, VZV
水痘-带状疱疹病毒，VZV

VZV only has one serotype.
VZV只有一种血清型

Diseases include:
相关疾病有

The primary infection is varicella,
原发感染，主要表现为水疱

also commonly referred
也通常被称为

to as “chicken pox”
“水痘”

The re-activated infection is zoster,
复发性感染是zoster（带状疱疹）

or shingles;
或shingles（带状疱疹）

and postherpetic neuralgia,
带状疱疹后神经痛

extremely painful due to nerve damage.
由神经损伤引起

Primary infection: varicella (chicken pox)
原发感染：水痘

Varicella occurs worldwide and
若没有疫苗接种计划

in the absence of a vaccination program,
世界上的

affects nearly every person
几乎每个人都可以得水痘

by his/her mid-adulthood.

Unlike primary HSV disease,
与原发性单纯疱疹病毒常引起隐形感染不同

varicella is normally symptomatic.
水痘通常都是显性感染

VZV is highly transmissible via
水痘-带状疱疹病毒的的传染性很强

respiratory droplets or by direct contact
可通过呼吸道飞沫或直接接触

with the vesicular skin lesions.
水疱的皮肤损伤传染

Unlike HSV, VZV spreads predominantly
与单纯疱疹病毒不同，VZV主要

by the respiratory route and,
通过呼吸道传播

after local replication
在呼吸道局部

in the respiratory tract,
复制增殖之后

by viremia to cause skin lesions

通过病毒血症，引起

over the entire body.
全身的皮疹

Pathogenesis of varicella.
水痘的发病机制

VZV is generally acquired by infection
水痘-带状疱疹病毒通常是通过

of the conjunctiva and/or mucosa
结膜和/或上呼吸道的

of upper respiratory tract.
粘膜感染

The virus replicates in the regional
病毒先在局部淋巴结增殖

lymph nodes before entering
再进入血液

the bloodstream causing
形成第一次

the primary viremia.
病毒血症

A secondary viremia occurs
病毒在肝脏或脾脏

after further viral replication
进一步增殖后

in the liver and spleen.
形成第二次病毒血症

Then the virus reaches the skin
然后病毒到达皮肤

and a vesicular rash appears.
并引起水疱性皮疹

The incubation period
潜伏期

is approximately 14 days.
大约持续14天

Varicella characteristically includes
水痘的特征症状包括

fever and a maculopapular rash.
发烧和斑丘疹

The characteristic rash of varicella
水痘皮疹的特征在于

is that after a few days all stages
感染几天后

of the lesion can be found
患者可出现

in the one patient at the same time,
各个阶段的皮疹

such as thin fluid-filled vesicles
从易破的薄壁水疱

and scabbed lesions.
到已经结痂的皮损

The primary infection
原发感染

is varicella (chickenpox).
是水痘

Then the viruses migrate up
然后病毒

the sensory nerve
沿感觉神经迁移

and remain latent (or dormant)
并潜伏（休眠）在

in the dorsal root ganglion
脊髓的

of the spinal cord.
背根神经节

Then, we have the reactivation:
病毒再次被激活时

herpes zoster (shingles).
表现为带状疱疹

50% of all individuals over 80 years old
50%的80岁以上的老人

or are immunocompromised
或免疫受损的人

will develop shingles.
会发生带状疱疹

Activation of the virus
应激或

in the spinal cord ganglion by stress
其他因素可以

or other stimuli,
激活潜伏在脊髓神经节中的病毒

is followed by viral migration down
病毒沿着感觉神经迁移

the sensory nerve causing shingles.
引起带状疱疹

Unlike HSV,
与单纯疱疹病毒不同

VZV is transmitted by aerosol
VZV通过气溶胶传播

and then spread by viremia
然后通过病毒血症扩散

to the target tissues (e.g., skin).
到靶组织（如皮肤）

Similar to HSV,
与单纯疱疹病毒类似

VZV establishes latency in neurons.
VZV也潜伏在神经元中

However,
然而

during reactivation/recurrence zoster
带状疱疹病毒的复发

results in viral replication
与病毒沿着整个神经支配的皮肤

and release along an entire dermatome,
增殖和释放有关

whereas the HSV virus is only deposited
然而，单纯疱疹病毒仅在

at the terminus of the nerve.
神经末端

The reasons why VZV becomes reactivated
水痘-带状疱疹病毒重新激活的诱因

is still completely unknown.
至今仍完全未知

Some investigators suggested that
一些研究者认为

the following conditions may participate
下列情况可能是

in viral reactivation stress;
刺激病毒再激活的因素

fatigue;
疲劳；

a weakened immune system (age-related, disease-related,
与年龄，疾病，或药物相关的免疫系统减弱

or drug-related); cancer;
肿瘤

radiation treatment;
放疗

a break in the rash-affected skin;
皮肤破损

and HIV/AIDS.
和艾滋病

Reactivation of latent varicella
水痘的复发感染

infection is zoster (shingles).
是带状疱疹

Zoster means “belt”.
Zoster表示“带”

The rash is limited to a dermatome
这种皮疹仅限于皮肤

and resembles varicella.
性状类似水痘

Patients develop a painful skin rash
患者会出现疼痛性的皮疹

with blisters in a limited area
并在身体一侧的有限区域内出现水疱

on one side of the body, often in a stripe.
通常呈条纹状

Shingles on the neck.
这是颈部的带状疱疹

Shingles on the chest.
胸部的带状疱疹

Shingles on the waist.
腰部的带状疱疹

Host response:
免疫性

Like that of HSV recurrence,
与单纯疱疹病毒复发类似

antibodies cannot
VZV抗体无法

prevent recurrence of zoster.
防止带状疱疹复发

Laboratory Diagnosis:
实验室检查

Detection of the infected cells
检测被感染的细胞

or viral antigens.
或检测病毒抗原

The CPEs in VZV-infected cells
VZV导致细胞的病变效应（CPE）

are similar to those seen
和HSV感染观察到的类似

in HSV-infected cells.

“Tzanck test” can be used.
可以使用Tzanck试验检测

In dermatopathology,
在皮肤病理学中

the Tzanck test,
Tzanck试验

also Tzanck smear,
也叫作Tzanck涂片

is scraping of an ulcer
是通过溃疡基底层刮片染色

base to look for Tzanck cells.
以寻找Tzanck细胞

It is sometimes also called
也被称为

the chicken pox skin test
水痘皮肤试验

and the herpes skin test.
和疱疹皮肤试验

Prevention and Treatment
预防和治疗

Varicella is a self-limiting disease
水痘是一种自限性疾病

and usually no treatment is necessary
通常不需要对得水痘的孩子

for children with chicken pox.
进行治疗

Treatment may be appropriate
治疗适用于

for adults and immunocompromised
成年人，免疫功能低下的

patients with VZV infections
VZV感染患者

and for people with shingles.
和那些得了带状疱疹的患者

Antiviral drugs,
抗病毒药物

such as ACV,
如阿昔洛韦（ACV）

famciclovir,
泛昔洛韦

and valacyclovir can be used
和伐昔洛韦

for the treatment of VZV infections.
都可以用来治疗VZV感染

Antiviral treatment can help
抗病毒治疗有助于

to reduce the severity
缓解症状

and duration of symptoms,
缩短症状持续时间

and to prevent complications.
和预防并发症

Varicella can be prevented
水痘可以通过

by the live-attenuated
接种减毒活疫苗

vaccine immunization.
来预防

Tai Chi,
太极

a popular style of Chinese Kung Fu
一种大众流行的中国功夫

or martial art,
或称之为武术

may help protect against shingles.
也有助于预防带状疱疹的复发

Story 2：Mrs. Zhang's “stripe rash”
故事2:张阿姨的“缠腰蛇”

Let's answer the questions now.
现在我们来回答这些问题

What is the disease?
她得了什么病？

She had shingles.
她得了带状疱疹

Why did she become infected?
她为何会被感染？

She is most likely
她很有可能

had chicken pox in childhood.
在小时候得过水痘

For some reasons,
由于某些原因

the latent virus
潜伏的病毒

became re-activated causing shingles.
被重新激活，导致了带状疱疹

And how do we treat the patient
那现在我们如何治疗患者

and protect others?
并保护其他人？

We can use antiviral drugs such
我们可以使用抗病毒药物，如

as ACV to reduce the severity
ACV来缓解症状和

and duration of symptoms.
缩短病程

Isolation,
隔离

personal hygiene and vaccination
讲究个人卫生和疫苗接种

can provide protection to others.
可以为其他人提供保护

Now, have a break.
现在，让我们休息一下

Next session,
下一节

we will finish the discussion
我们将结束对于

on herpesviruses.
疱疹病毒的讨论