The clinical spectra of VZV infection. The clinical spectra of VZV infection. (A) An otherwise healthy 2-year-old child with typical varicella (primary infection). (B) A child with underlying malignant disease receiving chemotherapy who died from disseminated varicella with pneumonia. (C) Salivary VZV DNA was demonstrated in a 72-year-old patient with severe unilateral neuropathic pain, which cleared on valacyclovir. There was no rash; VZV DNA was not detected in his saliva following recovery from pain. The diagnosis was zoster sine herpete. (D) Skin of wrist of a 71-year-old otherwise healthy woman with 7 tiny vesicles that caused severe itch but no pain. This was the extent of the rash, which resembled bites from a small insect. VZV DNA was demonstrated by PCR in skin vesicles and transiently in saliva. The diagnosis was mild HZ in an elderly woman. (E) Severe, disseminated HZ in a 35-year-old man with lymphoma on anticancer therapy, with severe pain, despite antiviral therapy. Anne A. Gershon, and Michael D. Gershon Clin. Microbiol. Rev. 2013; doi:10.1128/CMR.00052-13