title: A novel mutation of varicella-zoster virus associated to fatal hepatitis.
abstract: BACKGROUND
  Lethal varicella in immunocompetent hosts is rare and its pathogenesis is largely unknown. The discovery of glycoprotein E (gE) mutants showing attributes consistent with increased virulence in vitro and in animal models, provided a possible molecular mechanism underlying a more aggressive virus infection. However, these mutants have never been associated with unusually severe clinical cases.
  
  
  OBJECTIVE
  To varicella-zoster virus (VZV) mutations that correlate with increased virulence.
  
  
  RESULTS
  We report a case of fatal hepatitis caused by a VZV bearing a novel mutation on the 3B3 monoclonal antibody epitope of gE in an immunocompetent host.
  
  
  CONCLUSIONS
  This report describes a mutant VZV responsible for an aggressive clinical course in an immunocompetent host. Linking these severe clinical presentations of VZV infection to virus mutations might provide insights into the underlying pathogenic mechanisms.
authors.affiliation: Istituto di Anestesia e Rianimazione, Università di Roma Tor Vergata, Policlinico di Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. silvia.natoli@ptvonline.it
authors.forename: Silvia
authors.initials: S
authors.lastname: Natoli
authors.forename: Marco
authors.initials: M
authors.lastname: Ciotti
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Paba
authors.forename: Gian Piero
authors.initials: GP
authors.lastname: Testore
authors.forename: Giampiero
authors.initials: G
authors.lastname: Palmieri
authors.forename: Augusto
authors.initials: A
authors.lastname: Orlandi
authors.forename: Alessandro Fabrizio
authors.initials: AF
authors.lastname: Sabato
authors.forename: Francesca
authors.initials: F
authors.lastname: Leonardis
mesh_terms: D000293:Adolescent; D019943:Amino Acid Substitution; D002644:Chickenpox / Q000150:complications* / Q000821:virology*; D000939:Epitopes / Q000235:genetics / Q000276:immunology; D017809:Fatal Outcome; D006525:Hepatitis, Viral, Human / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000235:genetics* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D009154:Mutation; D013937:Thymidine Kinase / Q000235:genetics; D014759:Viral Envelope Proteins / Q000235:genetics / Q000276:immunology
chemical_list: D000939:Epitopes; D014759:Viral Envelope Proteins; C056913:glycoprotein E, varicella-zoster virus; D013937:Thymidine Kinase