Varicella zoster virus infections in neurological patients: a clinical study

Abstract

BackgroundVaricella zoster virus (VZV) reactivation is a common infectious disease in neurology and VZV the second most frequent virus detected in encephalitis. This study investigated characteristics of clinical and laboratory features in patients with VZV infection.MethodsTwo hundred eighty two patients with VZV reactivation that were hospitalized in the department of neurology in the time from 2005 to 2013 were retrospectively evaluated. Results from cerebrospinal fluid (CSF) analysis were available from 85 patients.ResultsTrigeminal rash was the most common clinical manifestation, followed by segmental rash, CNS infection, facial nerve palsy, postherpetic neuralgia, and radiculitis. MRI of the brain performed in 25/33 patients with encephalitis/meningitis did not show any signs of infection in the brain parenchyma. Only one patient showed contrast enhancement in the hypoglossal nerve. General signs of infection such as fever or elevated CRP values were found in only half of the patients. Furthermore, rash was absent in a quarter of patients with CNS infection and facial nerve palsy, and thus, infection could only be proven by CSF analysis. Although slight inflammatory CSF changes occurred in few patients with isolated rash, the frequency was clearly higher in patients with CNS infection and facial nerve palsy.ConclusionMonosegmental herpes zoster is often uncomplicated and a diagnostic lumbar puncture is not essential. In contrast, CSF analysis is an essential diagnostic tool in patients with skin lesions and cranial nerve or CNS affection. In patients with neuro-psychiatric symptoms and inflammatory CSF changes analysis for VZV should be performed even in the absence of skin lesions.

An improved animal model for herpesvirus encephalitis in humans

“…Ganglionitis as well as ganglioneuritis as seen in our model are usually not observed in patients suffering from HSV-1 associated encephalitis, except for one case report of cervical dorsal root ganglionitis without encephalitis [104]. However, for VZV patients such cases have been repeatedly described [16,105,106]. For HSV-1 and VZV, viral genomes have been detected independently in sensory and autonomic ganglia (e.g.…”

“…Meningoencephalitis occurs either after Varicella or Herpes Zoster in immunocompetent or immunosuppressed patients, representing as disseminated encephalomyelitis or inflammation with an unspecific distribution pattern [10]. As in HSV-1, clinical signs include alteration in mental status and focal neurological deficits, whereas the development of seizures is rare [14][15][16].…”

Evaluation of Next-Generation Sequencing for the Diagnosis of Infections of the Central Nervous System Caused by the Neurotropic Herpes Viruses: A Pilot Study

“…HSV-2 is usually sexually acquired and causes most cases of genital herpes [15], whereas HSV-1 is typically transmitted by oral to oral contact and could cause herpes labialis [12,16]. VZV is the second most frequent virus causing encephalitis or meningitis [4,17]. In addition to causing neurologic manifestation, VZV can result in varicella (chickenpox) and herpes zoster [12].…”

Clinical and magnetic resonance analysis of varicella-zoster virus (VZV) transcranial nerve into brain-induced brainstem encephalitis

“…In addition, 1/4 patients with central nervous system infections and facial paralysis have no rash, and the infection can only be demonstrated by cerebrospinal fluid analysis. Although a small number of patients with a simple rash have mild inflammatory cerebrospinal fluid changes, the incidence of central nervous system infection and facial paralysis is significantly higher [6]. The study which coexistence of cranial nerve-damaged and VZV encephalitis is rare.…”