Varicella Zoster Reactivation Causing Aseptic Meningitis in Healthy Adolescents

Barry, Rachel; Prentice, Michael B.; Costello, Daniel J.; O’Mahony, Olivia; deGascun, Cillian; Felsenstein, Susanna

doi:10.1097/inf.0000000000002759

Cited by 7 publications

(16 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although there have been substantial cases of varicella vaccine meningitis in the literature [ 2 , 6 , 7 ], our case is probably the second case of varicella vaccine meningitis without skin rash. However, VZV reactivations causing aseptic meningitis without rash associated with the past varicella infection have also been reported [ 1 , 8 ]; therefore, even in the absence of rash, in cases of aseptic meningitis, performing VZV PCR is crucial; moreover, if VZV test is positive, additional loop-mediated isothermal amplification assay [ 2 ] or metagenomic next-generation sequencing [ 7 ] for VZV to differentiate the vOka strain from the wild-type VZV strain is essential to confirm the etiology.…”

Section: Discussionmentioning

confidence: 99%

A Case of Aseptic Meningitis Without Rash Possibly Associated With Varicella Vaccine

Aoki¹,

Tanaka²,

Mizushiro³

et al. 2022

Cureus

View full text Add to dashboard Cite

Varicella-zoster virus (VZV) may cause aseptic meningitis in the pediatric age group. We describe a pediatric case of aseptic meningitis with a substantial increase of the paired serum antibody to VZV in which the child did not have skin rash during the course of illness. The patient was a 13-year-old boy without any history of exposure to VZV who was admitted with headache, vomiting, and low-grade fever. He had received one dose of varicella vaccine derived from the Oka/Biken strain (vOka) at the age of one year. Cerebrospinal fluid (CSF) analysis on admission revealed an elevated white blood cell count at 609/mm 3 with 99.6% mononuclear cells. As his symptoms resolved after lumbar puncture alone, he was discharged on the seventh day of hospitalization without receiving any specific medication. Serum VZV-IgG titer was found to be substantially elevated after two weeks. VZV infection and reactivations associated with vaccination, as well as past infections, should be included in the differential diagnoses of pediatric aseptic meningitis, even in the absence of skin rash in the entire course. Polymerase chain reaction (PCR) testing for VZV DNA in CSF should be performed in all cases, if available.

show abstract

Section: Discussionmentioning

confidence: 99%

A Case of Aseptic Meningitis Without Rash Possibly Associated With Varicella Vaccine

Aoki¹,

Tanaka²,

Mizushiro³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…A recent review of aseptic meningitis in children in Ireland reported 11 cases of VZV meningitis or meningoencephalitis in immune competent children with a prior history of childhood varicella but no herpes zoster [ 38 ]; in other words, these 11 children presumably had VZV reactivation in the CNS without clinical herpes zoster ( Figure 7 ). Of interest, 10 of the 11 children were adolescents between ages 12–16.…”

Section: Varicella Meningitis Caused By Wild Type Varicellamentioning

confidence: 99%

“…None of the children had herpes zoster prior to developing meningitis. Data from reference [ 38 ]. Age of wild type varicella: green bar; age of meningitis: red bar.…”

Section: Figurementioning

confidence: 99%

Twelve Children with Varicella Vaccine Meningitis: Neuropathogenesis of Reactivated Live Attenuated Varicella Vaccine Virus

Heusel

Grose

2020

Viruses

View full text Add to dashboard Cite

Varicella vaccine is a live attenuated varicella-zoster virus (VZV). Like its parental strain called VZV pOka, the vaccine virus vOka retains some neurotropic properties. To better understand vOka neuropathogenesis, we reassessed 12 published cases of vOka meningitis that occurred in once-immunized and twice-immunized children, all of whom had bouts of herpes zoster preceding the central nervous system infection. Eight of the 12 meningitis cases occurred in children who had received only one immunization. There was no pattern to the time interval between varicella vaccination and the onset of herpes zoster with meningitis. Four of the meningitis cases occurred in children who had received two immunizations. Since all four children were 14 years old when meningitis was diagnosed, there was a strong pattern to the interval between the first vaccination at age 1 year and onset of meningitis, namely, 13 years. Knowledge of pathogenesis requires knowledge of the location of herpes zoster; the majority of dermatomal rashes occurred at sites of primary immunization on the arm or thigh, while herpes zoster ophthalmicus was uncommon. Based on this literature review, currently there is no consensus as to the cause of varicella vaccine meningitis in twice-immunized children.

show abstract

“…1,2 VZV primary infection (chickenpox) normally occurs in preschool or schoolaged children.1 After the primary infection, the virus remains latent in cranial nerves, dorsal roots, and autonomic ganglia, and it may reactivate years after the primary infection as zoster. 1,3 Both chickenpox and zoster may have neurologic complications, mainly in immunocompromised or older patients. 1,3,4 Reactivation is linked to a decline in cell-mediated immunity, and so, associated with immunocompromised or older individuals, being exceedingly rare in paediatric immunocompetent patients.…”

mentioning

confidence: 99%

“…1,3 Both chickenpox and zoster may have neurologic complications, mainly in immunocompromised or older patients. 1,3,4 Reactivation is linked to a decline in cell-mediated immunity, and so, associated with immunocompromised or older individuals, being exceedingly rare in paediatric immunocompetent patients. 1,5 Pediatric reactivation cases seam to occur mainly when VZV-infection was acquired in the first year of life.…”

mentioning

confidence: 99%

Meningitis due to Varicella-Zoster virus reactivation without rash in an immunocompetent adolescent

et al. 2023

View full text Add to dashboard Cite

Varicella-zoster virus is a neurotropic virus that after the primary infection, usually manifested as chickenpox, may reactivate with infection of the central nervous system. When no skin lesions are present, a high clinical suspicion is required to reach the diagnosis. We report a case of an adolescent boy with varicella-zoster virus reactivation with meningitis in the absence of a zoster rash. Case ReportA 15-year-old boy was admitted to the emergency room with a nine-day history of persistent frontal headache. The headaches responded poorly to analgesia but had no other alarming features. Two days prior to admission, he complained of nausea, vomiting and hypersensitivity to light and loud noises. He had no fever, rash, or additional symptoms. DiscussionVaricella-zoster virus (VZV) is a neurotropic virus that

show abstract

Varicella Zoster Reactivation Causing Aseptic Meningitis in Healthy Adolescents

Cited by 7 publications

References 21 publications

A Case of Aseptic Meningitis Without Rash Possibly Associated With Varicella Vaccine

A Case of Aseptic Meningitis Without Rash Possibly Associated With Varicella Vaccine

Twelve Children with Varicella Vaccine Meningitis: Neuropathogenesis of Reactivated Live Attenuated Varicella Vaccine Virus

Meningitis due to Varicella-Zoster virus reactivation without rash in an immunocompetent adolescent

Contact Info

Product

Resources

About