1

Microorganism Profile

Identification of Academic Program (Course)

Instructor

Designation of Organization

Site

Date
 2

Introduction

Varicella-zoster (VZV) is a virus that causes chickenpox, shingles and other illnesses. It's in the

same family of viruses as herpes(Herpesviridae). Once you're infected with varicella-zoster, it stays in

your nerve cells, even after you've recovered from the illness. It can then reactivate and cause

additional symptoms. This is why people who had chickenpox as kids are at risk for shingles as

adults. With its double-stranded DNA, the virus is highly contagious. (Gershon et al. 2015).

Composition and Pathogenic Determinants

The varicella-zoster virus (VZV) is an enveloped virus with an icosahedral capsid covering linear

double-stranded DNA, consisting of a minimum of 70 different proteins required for its life cycle.

VZV grows mainly in host cells, using them for reproduction processes. VZV also has a glycoprotein-

covered complex envelope that allows entry into host cells and avoidance of immune system

detection, thus promoting increased survival and reduced immune response in the host organism

(Moffat et al. 2018).

Principal virulence determinants include Glycoproteins, specifically gB, gE, gH, and gI, essential

in viral adhesion, cell-to-cell dissemination, and immune evasion. Latency-associated transcripts

(LATs) enable persistence in sensory ganglia and avoidance from immune surveillance. Interference

with immune signalling: Varicella-zoster virus (VZV) modulates host interferon response and

interferes with antigen presentation, thus enabling it to escape immune system detection (Ouwendijk

et al., 2013).

Immune System Interaction

After infection with VZV for the first time, VZV is recognized by the innate immune system via

several pattern recognition receptors, such as Toll-like receptors (TLRs). This leads to type I

interferon production, which inhibits the virus until a stable balance is achieved concerning the

adaptive immune system (Ku et al., 2021). VZV antigens are phagocytosed and processed for innate

immunity, then presented to T cells via dendritic cells and macrophages, thus triggering an immune

response. Natural killer (NK) cells are responsible for clearing out the virus.
 3

In adaptive immunity, CD8+ cytotoxic T cells and CD4+ helper T cells can eliminate infections.

Neutralizing antibodies provide lasting immunity to future infections. However, despite immune

responses, VZV is in a latent state in the dorsal root ganglia and can reactivate later in life to cause

herpes zoster (shingles) (Gershon et al., 2015).

Infectious Disease Information

VZV leads to two serious illnesses, Varicella and chickenpox, which are defined by a blistering

skin eruption with a history and a sense of illness. Flat spots in the beginning and then raised spots,

small blisters, and eventually into scabs in 5 to 7 days. The standard course duration is 7 to 10 days.

Possible complications include encephalitis, pneumonia, bacterial superinfection, and congenital

varicella syndrome, most notably in pregnant women.

Factors that increase susceptibility to increased risks in a host include a history of immune

deficiency, impaired immune function, pregnancy, and childhood developmental stage. Individuals

with compromised immune systems, like HIV or cancer patients undergoing chemotherapy, show a

heightened susceptibility to serious health problems.

Herpes Zoster, or shingles, is a medical illness caused by a latent virus in a person. It is a painful

skin eruption localized to a certain area and marked by vesicular skin lesions. The course of a rash

usually lasts for about 2 to 4 weeks. Possible complications include postherpetic neuralgia (PHN),

shingles, and eye infections, all of which can cause visual impairments. With increased age,

compromised immune status, and psychological stress, a person is more likely to develop such

complications.

Epidemiology

Before vaccines were available, virtually all individuals were infected with VZV, the virus

responsible for causing chickenpox, by adulthood. With the varicella vaccine licensure, chickenpox

cases have declined sharply. However, shingles are still present in older individuals. Indeed, Humans
 4

represent the only known reservoir for this infection, with the main modes of entry being tiny airborne

droplets, direct contact with lesions, and vertical transmission to the fetus from mother to fetus in

utero. The main route for entry is via the respiratory tract's mucosal lining, where infectious virus is

present in vesicle fluid (Arvin, 2020).

Classification of Disease

Previously, Varicella was endemic throughout the world; however, nowadays, its distribution is

mostly limited to those who have not been vaccinated. Herpes zoster continues to reactivate with a

cyclical recurring pattern, making the disease a reportable illness.

A reportable illness is a disease that requires public health surveillance. When a public health

professional diagnoses a reportable illness, they are obligated to report it to public health authorities.

This system is useful in promoting government programs related to disease outbreak surveillance,

public health protection, and the institution of proper interventions. Health professionals in many

countries are required to report cases of chickenpox to assess whether or not the vaccine is effective.

However, cases of shingles do not usually require reporting.

Prevention

Healthcare practitioners should wear Personal Protective Equipment (PPE) such as masks and

gloves when dealing with VZV-infected patients to reduce the risks associated with transmission.

Lifestyle and Sanitation: Frequent washing and isolation from affected individuals reduce

transmission.

Vaccination

Varicella vaccine (live, weakened): This vaccine elicits lifetime immunity to chickenpox. The

recombinant zoster vaccine is given to those 50 and older to prevent the onset of herpes zoster and its

complications (Dooling et al., 2018).

Intervention
 5

For Herpes Zoster, treatment is achieved by administering antiviral drugs like Acyclovir,

valacyclovir, or famciclovir. These drugs are recommended to relieve symptoms and reduce the

severity and complications of the condition.

Pharmaceutical Agents

Acyclovir is administered in subjects at high risk of Varicella, but the majority of cases are self-

limiting. Supportive Therapies, including Opioid or NSAID pain control and corticosteroids, also

become vital in cases with evident inflammation.

Antimicrobial Resistance: Long-term antiviral therapy for infections like varicella-zoster virus (VZV)

is uncommon. However, it can lead to resistant strains, complicating treatment options and patient

outcomes. (Petersen et al., 2020).

Clinical Relevance In the Nursing Field

The early identification of VZV infection in immunocompromised individuals is crucial. Infection

control measures, such as isolation and hygiene, can prevent nosocomial outbreaks. Nurses also

promote vaccination, which is most effective in preventing herpes zoster and Varicella. In conclusion,

VZV is a genetically altered pathogen causing Varicella in the initial infection and is linked with the

reactivation of herpes zoster. Although a reduction in incidence due to vaccines has been observed,

VZV still presents serious challenges, specifically in elderly and immunocompromised individuals,

where incidence rates are high. Clinicians should completely understand such populations about

epidemiological factors, immune responses, and prevention and management strategies.

Conclusion

Varicella-zoster is a very contagious virus that causes chickenpox, which is characterized by

blistering, skin eruption and raised spots. The patient may also have scabs after 5 to 7 days. The

mentioned virus has a double-stranded DNA and unique ability to cause primary and recurrent

infections. Even though some attempts to come up with a viral vaccination solution, the virus has

been a continuous threat, particularly to older people who may suffer serious complications due to the
 6

infection. Preventive measures put in place for slowing the viral multiplication and infection,

including using personal protective equipment, good hygiene practices, and vaccination, have been

vital. On the other hand, viral treatments have also been effective, such as administering Acyclovir

and valacyclovir. Consequently, antiviral research is also in progress, and the vital course of

addressing emerging challenges associated with the virus has

Reference
 7

Arvin, A. M. (2020). Varicella-zoster virus. Clinical Microbiology Reviews, 9(3), 361–381.

[Link]

Dooling, K. L., Guo, A., Patel, M., Lee, G. M., Moore, K., Belongia, E. A., & Harpaz, R. (2018).

Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster

Vaccines. MMWR. Morbidity and Mortality Weekly Report, 67(3), 103–108.

[Link]

Gershon, A. A., Breuer, J., Cohen, J. I., Cohrs, R. J., Gershon, M. D., Gilden, D., Grose, C.,

Hambleton, S., Kennedy, P. G. E., Oxman, M. N., Seward, J. F., & Yamanishi, K. (2015). Varicella

zoster virus infection. Nature Reviews Disease Primers, 1(1). [Link]

Ku, E. J., Lee, D.-H., Jeon, H. J., & Oh, T. K. (2021). Long-term effectiveness and safety of quadruple

combination therapy with empagliflozin versus dapagliflozin in patients with type 2 diabetes: 3-year

prospective observational study. Diabetes Research and Clinical Practice, 182, 109123.

[Link]

Moffitt, J. R., Bambah-Mukku, D., Eichhorn, S. W., Vaughn, E., Shekhar, K., Perez, J. D., Rubinstein,

N. D., Hao, J., Regev, A., Dulac, C., & Zhuang, X. (2018). Molecular, spatial, and functional single-

cell profiling of the hypothalamic preoptic region. Science, 362(6416), eaau5324.

[Link]

Ouwendijk, W. J. D., Mahalingam, R., de Swart, R. L., Haagmans, B. L., van Amerongen, G., Getu,

S., Gilden, D., Osterhaus, A. D. M. E., & Verjans, G. M. G. M. (2013). T-Cell Tropism of Simian

Varicella Virus during Primary Infection. PLoS Pathogens, 9(5), e1003368.

[Link]

Petersen, N., König, H.-H., & Hajek, A. (2020). The link between falls, social isolation and

loneliness: A systematic review. Archives of Gerontology and Geriatrics, 88(88), 104020.

[Link]
8