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Muacevic A, Adler JR, Tanaka S, Matsuda N, Kanai K. Mollaret Meningitis Caused by Varicella-Zoster Virus: A Case Report. Cureus 2022; 14:e31834. [PMID: 36579293 PMCID: PMC9788859 DOI: 10.7759/cureus.31834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/24/2022] Open
Abstract
Mollaret meningitis is a recurrent aseptic meningitis mostly caused by herpes simplex virus type 2. Other causes of the disease rarely exist, and its pathology is not well understood. Herein, we present a 57-year-old man who had been admitted to our hospital eight times with recurrent aseptic meningitis. Although the deoxyribonucleic acid (DNA) of varicella-zoster virus (VZV) was not detected in the cerebrospinal fluid (CSF), his genetic analysis, measurement of anti-VZV immunoglobulin-G (IgG) in the CSF, the VZV IgG index, IgG in the serum, and interleukin-1 beta in the CSF revealed that the Mollaret meningitis had been caused by the VZV. This case demonstrates that Mollaret meningitis can be caused by the VZV when specific factors are associated with decreased immune response. This case is valuable in elucidating the pathophysiology of Mollaret meningitis.
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2
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Motohashi S, Takahashi J, Umehara T, Komatsu T, Murakami H, Iguchi Y. [A 73-year-old man with polyradiculopathy and multiple cranial neuropathies emerging separate from the originating dermatome of a varicella zoster skin lesion]. Rinsho Shinkeigaku 2022; 62:380-385. [PMID: 35474287 DOI: 10.5692/clinicalneurol.cn-001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 73-year-old man developed delayed-onset multiple cranial neuropathies of cranial nerves V, VII and VIII, and segmental paresis in the ipsilateral upper extremity related to the C4 to Th1 segment, after all skin lesions with varicella zoster (VZV) on the left neck of the C3-4 dermatome had dried and crusted over. On admission, cerebrospinal fluid (CSF) revealed pleocytosis (all mononuclear cells, 12/μl). Treatment was started with intravenous acyclovir (10 mg/kg, every 8 h for 14 days) and methylprednisolone (1,000 mg/day for 3 days). Four days after starting treatment, left segmental paresis was improved, but the multiple cranial neuropathies persisted. Oral prednisolone (0.5 mg/kg/day) was administered for 5 days, then tapered off. All neurological symptoms had disappeared by hospital day 23. Of particular interest was the discrepancy between skin regions affected by VZV (C3-4) and the regions of cranial neuropathy (cranial nerves V, VII, and VIII) and muscle weakness innervated by C4-Th1. Although CSF was negative for VZV DNA according to PCR testing, the antibody index for VZV was elevated. This suggests intrathecal synthesis of VZV antibodies and supports the diagnosis of VZV meningitis. Also, all cranial nerves involved in this case were reported to have the cranial nerve ganglia where VZV could have established latency and been reactivated. This suggests concurrent reactivation on each cranial nerve ganglia without cutaneous lesions, as zoster sine herpete. In addition, anastomoses among the upper cervical nerves, which are found in some patients, may have contributed to this condition. These mechanisms underlie various neurological symptoms associated with VZV infection.
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Affiliation(s)
| | | | - Tadashi Umehara
- Department of Neurology, The Jikei University School of Medicine
| | - Teppei Komatsu
- Department of Neurology, The Jikei University School of Medicine
| | | | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine
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3
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Gaudin M, Theïs C, Mrozek N, Brebion A, Henquell C, Jacomet C, Vidal M. Varicella zoster virus and meningitis in immunocompetent patients: Specificity and questions. CLINICAL INFECTION IN PRACTICE 2022. [DOI: 10.1016/j.clinpr.2021.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sahra S, Jahangir A, Glaser A, Mobarakai N, Jahangir A. Case report: aseptic meningitis secondary to varicella-zoster virus (VZV) without an exanthem post MMR vaccination. BMC Infect Dis 2021; 21:746. [PMID: 34344345 PMCID: PMC8330204 DOI: 10.1186/s12879-021-06453-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Varicella-zoster virus (VZV) is a known cause of aseptic meningitis, with a predisposition for an immunocompromised population. A dermatomal rash usually accompanies aseptic meningitis secondary to VZV. CASE PRESENTATION We report the case of a 31-year-old male with a history of chickenpox in childhood and recent shingles who presented with severe frontal headaches secondary to VZV meningitis. The patient had also recently received the measles-mumps-rubella (MMR) vaccine. He recovered without any neurological sequala. CONCLUSION This case report describes an immunocompetent patient with recent MMR vaccination who developed aseptic meningitis secondary to VZV without any dermatomal involvement (Zoster Sine Herpete).
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Affiliation(s)
- Syeda Sahra
- Department of Internal Medicine, Hofstra School of Medicine, Staten Island University Hospital, 475-Seaview Avenue, Staten Island, NY, 10305, USA.
| | - Abdullah Jahangir
- Department of Internal Medicine, Hofstra School of Medicine, Staten Island University Hospital, 475-Seaview Avenue, Staten Island, NY, 10305, USA
| | - Allison Glaser
- Department of Internal Medicine, Hofstra School of Medicine, Staten Island University Hospital, 475-Seaview Avenue, Staten Island, NY, 10305, USA
| | - Neville Mobarakai
- Department of Internal Medicine, Hofstra School of Medicine, Staten Island University Hospital, 475-Seaview Avenue, Staten Island, NY, 10305, USA
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5
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Kato H, Murakami T, Tajiri Y, Hanajima R. [Successful early treatment with acyclovir and corticosteroids for acute myelitis associated with zoster sine herpete: a case report]. Rinsho Shinkeigaku 2020; 60:485-488. [PMID: 32536667 DOI: 10.5692/clinicalneurol.60.cn-001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 79-year-old man presented with chest and back pain on the right side but with no cutaneous lesions. He had received oral corticosteroids and immunosuppressants for systemic lupus erythematosus. He had spastic paraplegia, sensory disturbance in the lower limbs, and dysfunction of the bladder and bowel. He showed mononuclear-dominant pleocytosis and elevated proteins in the cerebrospinal fluid (CSF), and a decreased CSF/blood glucose ratio. Although polymerase chain reaction techniques found no varicella-zoster virus (VZV) DNA, VZV IgG antibodies were elevated in both the serum and CSF, and the VZV IgG index was dramatically elevated. MRI revealed no lesions in the brain or spine. However, somatosensory evoked potentials in the tibial nerve showed abnormal prolongation of the central sensory conduction time. We diagnosed the patient with acute myelitis associated with zoster sine herpete (ZSH). He received acyclovir and intravenous methylprednisolone pulse therapy in the early stage, and his symptoms and CSF findings completely recovered. We conclude that acute myelitis associated with ZSH should be treated as soon as possible because VZV infection may induce necrotizing myelitis if the treatment is delayed.
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Affiliation(s)
- Hiroyuki Kato
- Department of Neurology, Tottori Prefectural Kousei Hospital
| | | | - Yuki Tajiri
- Department of Neurology, Tottori Prefectural Kousei Hospital
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University
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Takeshima S, Shiga Y, Himeno T, Tachiyama K, Kamimura T, Kono R, Takemaru M, Takeshita J, Shimoe Y, Kuriyama M. [Clinical, epidemiological and etiological studies of adult aseptic meningitis: Report of 11 cases with varicella zoster virus meningitis]. Rinsho Shinkeigaku 2017; 57:492-498. [PMID: 28804114 DOI: 10.5692/clinicalneurol.cn-001054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We treated 11 cases (52.7 ± 14.9 years, all male) with varicella zoster virus (VZV) meningitis and 437 cases with adult aseptic meningitis from 2004 to 2016. The incidence rate of adult VZV meningitis in the cases with aseptic meningitis was 2.5%. Herpes zoster infections are reported to have occurred frequently in summer and autumn. VZV meningitis also occurred frequently in the similar seasons, in our patients. The diagnoses were confirmed in 9 cases with positive VZV-DNA in the cerebrospinal fluid and in 2 cases with high VZV-IgG indexes (> 2.0). For diagnosis confirmation, the former test was useful for cases within a week of disease onset, and the latter index was useful for cases after a week of disease onset. Zoster preceded the meningitis in 8 cases, while the meningitis preceded zoster in 1 case, and 2 cases did not have zoster (zoster sine herpete). Two patients were carriers of the hepatitis B virus, 1 patient was administered an influenza vaccine 4 days before the onset of meningitis, and 1 patient was orally administered prednisolone for 2 years, for treatment. Their immunological activities might have been suppressed. The neurological complications included trigeminal neuralgia, facial palsy (Ramsay Hunt syndrome), glossopharyngeal neuralgia, and Elsberg syndrome. Because the diseases in some patients can become severe, they require careful treatment.
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Affiliation(s)
- Shinichi Takeshima
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
- Present address: Department of Rehabilitation Medicine, Showa University School of Medicine
| | - Yuji Shiga
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Takahiro Himeno
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Keisuke Tachiyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
- Present address: Hiroshima City Hiroshima Citizens Hospital
| | - Teppei Kamimura
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
- Present address: National Central and Cardiovascular Center
| | - Ryuhei Kono
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Jun Takeshita
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center, Ota Memorial Hospital
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7
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Yamashita H, Ueda Y, Takahashi Y, Akio M. [A case of adult-onset varicella pneumonia and varicella-zoster virus (VZV) meningitis resulting from a reoccurrence of varicella]. KANSENSHOGAKU ZASSHI. THE JOURNAL OF THE JAPANESE ASSOCIATION FOR INFECTIOUS DISEASES 2012; 86:306-9. [PMID: 22746055 DOI: 10.11150/kansenshogakuzasshi.86.306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The patient was a 74-year old male who presented with a skin rash, cough, and impaired consciousness. A diffuse, systemic, dark red rash was observed and he was admitted. Varicella infection was diagnosed based on the varicella-zoster virus (VZV)-IgM levels. The extremely high VZV- IgG levels observed were unlikely to be present in an initial infection and the infection was thought to be a reoccurrence. Diffuse nodular shadows measuring < or = 5 mm in diameter were observed on chest computed tomography (CT);this was consistent with the typical imaging findings of varicella pneumonia. The cerebrospinal fluid (CSF) was positive for CSF VZV-IgM antibody, CSF VZV-PCR, and CSF antibody titer index. A diagnosis of varicella meningitis was made. When both respiratory and neurological symptoms are observed in patients with varicella infection, it is necessary to consider a combined diagnosis of varicella pneumonia and varicella meningitis/encephalitis and perform chest imaging and a CSF examination. Repeated asymptomatic re-infection is considered necessary in order to maintain a lifelong immunity to varicella; however, the opportunities for asymptomatic re-infection are decreasing with the declining birth rate and trend toward small families. As a result, reoccurrences of varicella infection in the elderly are expected to increase with rapidly increasing longevity.
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Affiliation(s)
- Hiroyuki Yamashita
- National Center for Global and Health Medicine, Division of Rheumatology
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8
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Inukai A, Katayama T, Kenjo M, Yokokawa Y, Aiba I, Saito Y. [A patient with myelitis of varicella-zoster without skin lesions--diagnostic value of virus antibody index in CSF]. Rinsho Shinkeigaku 2010; 50:634-40. [PMID: 20960928 DOI: 10.5692/clinicalneurol.50.634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A previously healthy 55-year-old woman developed abnormal sensation on the right occipital region. It expanded for the following three weeks. On admission, examination revealed abnormal and decreased sensation in touch and pinprick at right C2 to C6 dermatome without skin lesion. There was no muscle weakness. Deep tendon reflexes were more active in the right than in the left. MRI demonstrated a lesion of isointensity on T1-weighted, hyperintensity on T2-weighted, which was enhanced with contrast material on gadolinium-enhanced T1-weighted image at the upper cervical spinal cord corresponding to C2. Laboratory studies showed no immunosuppression and autoantibodies. The antibody index to varicella-zoster virus (VZV) was elevated in the cerebrospinal fluid (CSF). This finding prompted us to a diagnosis of myelitis of zoster sine herpete. VZV is thought to be a causative agent in cases of CNS infections of unknown etiology such as myelitis, even in the absence of skin manifestations. Amplification of VZV DNA by PCR in the CSF and the detection of an intrathecal production of anti-VZV antibodies have important diagnostic value, although their presence depends on the timing of the CSF sampling. The percentage of PCR-positive cases drops after seven or ten days, whereas that of specific antibodies-positive cases elevates. Because VZV myelitis are usually protracted, PCR does not always provide an exquisite sensitivity. Thus, the evaluation of antibody index provides the evidence of intrathecal production of anti-VZV antibodies. That is expressed as CSF antibody titer/serum antibody titer/CSF IgG/serum IgG. This quotient superior to 1.5 or 2.0 suggests CNS synthesis. As the sample of our patient was taken relatively late, this value was diagnostic. We would like to emphasize the importance of making precise diagnosis and adequate initial treatment in patients with myelitis of unknown etiology even if there is no skin lesions.
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Affiliation(s)
- Akira Inukai
- Department of Neurology, National Hospital Organization Higashi Nagoya National Hospital
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9
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Gunson RN, Aitken C, Gilden D. A woman with acute headache and sacral dermatomal numbness. J Clin Virol 2010; 50:191-3. [PMID: 21130028 DOI: 10.1016/j.jcv.2010.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 11/01/2010] [Indexed: 12/29/2022]
Affiliation(s)
- R N Gunson
- West of Scotland Specialist Virology Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom.
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10
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Neurological disease produced by varicella zoster virus reactivation without rash. Curr Top Microbiol Immunol 2010; 342:243-53. [PMID: 20186614 DOI: 10.1007/82_2009_3] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Reactivation of varicella zoster virus (VZV) from latently infected human ganglia usually produces herpes zoster (shingles), characterized by dermatomal distribution pain and rash. Zoster is often followed by chronic pain (postherpetic neuralgia or PHN) as well as meningitis or meningoencephalitis, cerebellitis, isolated cranial nerve palsies that produce ophthalmoplegia or the Ramsay Hunt syndrome, multiple cranial nerve palsies (polyneuritis cranialis), vasculopathy, myelopathy, and various inflammatory disorders of the eye. Importantly, VZV reactivation can produce chronic radicular pain without rash (zoster sine herpete), as well as all the neurological disorders listed above without rash. The protean neurological and ocular disorders produced by VZV in the absence of rash are a challenge to the practicing clinician. The presentation of these conditions varies from acute to subacute to chronic. Virological confirmation requires the demonstration of amplifiable VZV DNA in cerebrospinal fluid (CSF) or in blood mononuclear cells, or the presence of anti-VZV IgG antibody in CSF or of anti-VZV IgM antibody in CSF or serum.
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11
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Habib AA, Gilden D, Schmid DS, Safdieh JE. Varicella zoster virus meningitis with hypoglycorrhachia in the absence of rash in an immunocompetent woman. J Neurovirol 2009; 15:206-8. [PMID: 19255900 DOI: 10.1080/13550280902725550] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report varicella-zoster virus (VZV) meningitis in a healthy adult woman with no antecedent rash and with hypoglycorrhachia. Cerebrospinal fluid (CSF) examination revealed the presence of VZV DNA, anti-VZV immunoglobulin G (IgG) antibody, and intrathecal production of anti-VZV IgG antibody.
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Affiliation(s)
- Ali A Habib
- Department of Neurology, New York Presbyterian Hospital Weill Cornell Medical College, New York, New York, USA
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12
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Varicella zoster virus associated acute aseptic meningitis without exanthem in an immunocompetent 14-year-old boy. Pediatr Infect Dis J 2008; 27:362-3. [PMID: 18316987 DOI: 10.1097/inf.0b013e318160ee11] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurologic complications can occur with varicella-zoster virus (VZV) infection, usually after vesicular exanthem. We report the case of a previously healthy 14-year-old boy with aseptic meningitis as a result of reactivated-VZV infection without exanthem. Diagnosis was made by detection of VZV-DNA in cerebrospinal fluid. VZV should be considered in cases of aseptic meningitis, even without a history of exanthem or immune compromise.
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13
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Abstract
Varicella-zoster virus causes varicella (chickenpox) and zoster (shingles). Neurologic manifestations occur in both illnesses. We describe a previously healthy child who had aseptic meningitis without exanthem caused by reactivation of varicella-zoster virus. This has not been previously reported in the pediatric literature.
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Affiliation(s)
- Ravi Jhaveri
- Division of Infectious Diseases, Mattel Children's Hospital at UCLA, Los Angeles, CA 90095-1752, USA.
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14
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Ueno M, Oka A, Koeda T, Okamoto R, Takeshita K. Unilateral occlusion of the middle cerebral artery after varicella-zoster virus infection. Brain Dev 2002; 24:106-8. [PMID: 11891103 DOI: 10.1016/s0387-7604(02)00005-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a 4-year-old child who developed hemiplegia 6 months after varicella-zoster virus (VZV) infection. Cerebral angiography showed complete occlusion of the right middle cerebral artery with basal moyamoya vessels. Elevation of anti-VZV antibody in the cerebrospinal fluid indicated central nervous system involvement. The association between VZV cerebral angitis and unilateral occlusion of right middle cerebral artery is discussed.
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Affiliation(s)
- Makoto Ueno
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 36-1 Nishi-machi, Yonago 683-8504, Japan.
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15
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Abstract
Varicella-zoster virus (VZV) causes chickenpox (varicella), becomes latent in cranial nerve and dorsal root ganglia, and can reactivate many years later to produce shingles (zoster) and postherpetic neuralgia (PHN). Elderly and immunocompromised individuals are also at risk for complications of VZV reactivation involving the central nervous system (CNS), including myelitis, large-vessel encephalitis/granulomatous arteritis, small-vessel encephalitis, meningoencephalitis, and ventriculitis. Peripheral nervous system (PNS) complications range from zoster and postherpetic neuralgia to postinfectious polyneuritis (Guillain-Barre syndrome, GBS). These complications can occur with or without cutaneous manifestations. An increase in elderly and immunocompromised individuals will likely result in a higher prevalence of these conditions; therefore, VZV can be seen as a "re-emerging" infection of the early twenty-first century. In this review, we summarize our experience and the existing literature on CNS and PNS complications of VZV reactivation. Special attention is paid to reports of complications without rash, as these entities are more difficult to diagnose.
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Affiliation(s)
- J J LaGuardia
- Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA
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16
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Casas I, Tenorio A, Echevarría JM, Klapper PE, Cleator GM. Detection of enteroviral RNA and specific DNA of herpesviruses by multiplex genome amplification. J Virol Methods 1997; 66:39-50. [PMID: 9220389 DOI: 10.1016/s0166-0934(97)00035-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A reverse transcription (RT) multiplex polymerase chain reaction (PCR) assay was developed to allow rapid, sensitive and simultaneous detection of enteroviral RNA and herpesviral DNA specific sequences in a single tube. The method involves a reverse transcription step followed by a multiplex nested PCR in which the combination of primers amplifies cDNA from enteroviruses and specific herpesviruses DNA. Nested amplification utilises primers designed to anneal into the amplification product from the first reaction. Individual viruses were then detected and differentiated by the size of their PCR products determined using ethidium bromide stained agarose gels. To exclude false negatives due to sample inhibitors an internal amplification control, a cloned fragment of DNA from Pseudorabies virus (PRV DNA) was included in the reaction mixture. Detection levels between 0.01 and 0.001 TCID50 of prototype strains of Polio and Coxsackie type B viruses and between 1 and 100 molecules of cloned-DNA of herpesviruses prototype strains were achieved. The RT multiplex PCR method proved capable of detecting enteroviral RNA or herpesviral DNA in cerebro spinal fluid (CSF) samples from patients with aetiologically well characterized encephalitis or aseptic meningitis.
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MESH Headings
- Child
- Child, Preschool
- DNA, Viral/analysis
- Encephalitis, Viral/cerebrospinal fluid
- Encephalitis, Viral/pathology
- Encephalitis, Viral/virology
- Enterovirus/genetics
- Enterovirus/isolation & purification
- Female
- Genome, Viral
- Herpesviridae/genetics
- Herpesviridae/isolation & purification
- Humans
- Infant
- Male
- Meningitis, Aseptic/virology
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/pathology
- Meningitis, Viral/virology
- Polymerase Chain Reaction/methods
- RNA, Viral/analysis
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Affiliation(s)
- I Casas
- Diagnostic Microbiology Service, Centro Nacional de Microbiología, Madrid, Spain.
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17
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Aizawa H, Suzutani T, Yahara O, Gotoh R, Morita K, Minami H, Sasaki N, Tobise K. A case of varicella-zoster myelopathy. Acta Neurol Scand 1996; 93:470-2. [PMID: 8836311 DOI: 10.1111/j.1600-0404.1996.tb00028.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Early diagnosis of neurological complications of varicella-zoster virus (VZV) is important because of its treatability. We performed polymerase chain reaction (PCR) to detect VZV-DNA from the cerebrospinal fluid (CSF) of a patient with myelopathy. PATIENT & METHODS A 69-year-old man developed sensory disturbances in the lower extremities and bladder-bowel disturbances, followed by cutaneous zoster on his left arm. Polymerase chain reaction was applied to identify the viral DNA in CSF. RESULTS The increased antibody index of VZV and herpes simplex virus (HSV) in the CSF suggested intrathecal synthesis of IgG antibodies to these viruses. VZV-DNA was detected in the CSF by nested PCR, but neither HSV-1 nor HSV-2 DNA was detected in CSF. He was successfully treated with acyclovir and prednisolone. CONCLUSION PCR may be a useful tool for the diagnosis of VZV myelopathy.
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Affiliation(s)
- H Aizawa
- Department of Internal Medicine, National Hospital Nayoro, Japan
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18
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Echevarría JM, Casas I, Tenorio A, de Ory F, Martínez-Martín P. Detection of varicella-zoster virus-specific DNA sequences in cerebrospinal fluid from patients with acute aseptic meningitis and no cutaneous lesions. J Med Virol 1994; 43:331-5. [PMID: 7964642 DOI: 10.1002/jmv.1890430403] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute aseptic meningitis (AAM) is considered as an uncommon manifestation of varicella-zoster virus (VZV) recrudescence and is usually regarded as a complication of the cutaneous infection in patients with impaired cellular immunity. Indirect evidence suggests, however, that VZV-associated AAM may also respond to direct spread of the virus to the leptomeninges from the cells supporting the latency. The polymerase chain reaction (PCR) was used to amplify VZV-specific DNA sequences in serial cerebrospinal fluid (CSF) samples from 21 patients with AAM, who presented laboratory evidence of intrathecal production of VZV-specific antibody on follow-up. Eleven of these patients never showed cutaneous zosteriform lesions. VZV-DNA sequences were detected in the CSF from all patients with cutaneous zoster, as well as from six patients (55%) lacking skin lesions. Viral DNA sequences were present in six cases before the rise in specific antibody was seen in CSF, disappearing during follow-up in the seven positive cases. These results support the proposed involvement of VZV in the etiology of AAM seen among normal young adults and strongly suggest that the virus can reach directly and infect the CNS from the latently infected spinal ganglia.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Aged
- Antibodies, Viral/blood
- Antibodies, Viral/cerebrospinal fluid
- Base Sequence
- Child
- DNA, Viral/cerebrospinal fluid
- Herpes Zoster/cerebrospinal fluid
- Herpes Zoster/immunology
- Herpes Zoster/virology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Herpesvirus 3, Human/isolation & purification
- Humans
- Immunoglobulin G/blood
- Immunoglobulin G/cerebrospinal fluid
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Aseptic/immunology
- Meningitis, Aseptic/virology
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/immunology
- Meningitis, Viral/virology
- Middle Aged
- Molecular Sequence Data
- Polymerase Chain Reaction
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Affiliation(s)
- J M Echevarría
- Servicio de Microbiología Diagnóstica, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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19
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Affiliation(s)
- K J Elliott
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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Puchhammer-Stöckl E, Popow-Kraupp T, Heinz FX, Mandl CW, Kunz C. Detection of varicella-zoster virus DNA by polymerase chain reaction in the cerebrospinal fluid of patients suffering from neurological complications associated with chicken pox or herpes zoster. J Clin Microbiol 1991; 29:1513-6. [PMID: 1653267 PMCID: PMC270144 DOI: 10.1128/jcm.29.7.1513-1516.1991] [Citation(s) in RCA: 143] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The polymerase chain reaction (PCR) was used to detect varicella-zoster virus (VZV) DNA in the cerebrospinal fluid of patients with VZV infection associated with neurological symptoms. Positive results were obtained in three of five children with post-chicken pox cerebellitis and in seven of seven herpes zoster patients with neurological symptoms. The PCR thus provides a useful tool for the early diagnosis of VZV-associated neurological disease.
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Echevarría J, de Ory F, León P, Téllez A, Martínez-Martin P, Martín-Fontelos P. Comparative sensitivity of different criteria for interpreting antibody tests in cerebrospinal fluid from patients with acute viral meningitis. ACTA ACUST UNITED AC 1990. [DOI: 10.1016/0888-0786(90)90004-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- H M Heller
- State University of New York, Stony Brook
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Echevarría JM, de Ory F, León P, Téllez A. Definition of high-proficiency serological markers for diagnosis of varicella-zoster virus infections by enzyme immunoassay. J Med Virol 1989; 27:224-30. [PMID: 2542432 DOI: 10.1002/jmv.1890270308] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The levels of Varicella-zoster virus (VZV)-specific IgG, IgM, and IgA antibodies produced in 22 cases of varicella, 22 cases of cutaneous zoster, and 12 cases of acute aseptic meningitis due to VZV in the absence of cutaneous lesions, were measured by indirect enzyme immunoassay (EIA) and compared with those observed in a group of 34 age-matched controls. The definition of cutoff titres for each serological marker and combinations of them allowed early diagnosis of infection in 82% of varicella patients and 91% of patients with acute aseptic meningitis lacking cutaneous lesions on a single serum sample, the specificity being over 90%. The system was as sensitive as the demonstration of intrathecally produced IgG antibodies for the early diagnosis of the infection in 22 cases of neurological disease due to VZV. A working protocol for the serological diagnosis of VZV infections, using currently available EIA reagents, is described.
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Affiliation(s)
- J M Echevarría
- Centro Nacional de Microbiología, Virología e Inmunología Sanitarias, Madrid, Spain
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Dalakas MC, Stone G, Elder G, Ceroni M, Madden D, Román G, Sever JL. Tropical spastic paraparesis: clinical, immunological, and virological studies in two patients from Martinique. Ann Neurol 1988; 23 Suppl:S136-42. [PMID: 2894805 DOI: 10.1002/ana.410230732] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Two patients from Martinique with tropical spastic paraparesis had antibodies to human T-lymphotropic virus type I (HTLV-I) in serum and spinal fluid but no antibodies to other retroviruses tested. They presented with spastic weakness of both lower extremities, hyperreflexia with upgoing toes, sphincteric dysfunction, and normal sensation. By means of agarose isoelectric focusing and selective immunoblotting we demonstrated an increased intrathecal synthesis of IgG antibodies to HTLV-I in the spinal fluid. Unique oligoclonal bands of IgG antibodies to HTLV-I were present in the cerebrospinal fluid. Using a battery of monoclonal antibodies we also found in these patients an increased number of circulating T cells that expressed activation markers. We conclude that the HTLV-I retrovirus associated with tropical spastic paraparesis has both lymphocytotropic and neurotropic properties.
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Affiliation(s)
- M C Dalakas
- National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, MD 20892
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Goudsmit J, Epstein LG, Paul DA, van der Helm HJ, Dawson GJ, Asher DM, Yanagihara R, Wolff AV, Gibbs CJ, Gajdusek DC. Intra-blood-brain barrier synthesis of human immunodeficiency virus antigen and antibody in humans and chimpanzees. Proc Natl Acad Sci U S A 1987; 84:3876-80. [PMID: 3473487 PMCID: PMC304979 DOI: 10.1073/pnas.84.11.3876] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The presence of human immunodeficiency virus (HIV) antigens in cerebrospinal fluid (CSF) was associated with progressive encephalopathy in adult and pediatric patients with acquired immunodeficiency syndrome (AIDS). HIV antigen was detected in CSF from 6 of 7 AIDS patients with progressive encephalopathy. By contrast, HIV antigen, whether free or complexed, was detected in CSF from only 1 of 18 HIV antibody seropositive patients without progressive encephalopathy and from 0 of 8 experimentally infected chimpanzees without clinical signs. Intra-blood-brain barrier synthesis of HIV-specific antibody was demonstrated in the majority of patients with AIDS (9/12) or at risk for AIDS (8/13) as well as in the experimentally infected chimpanzees, indicating HIV-specific B-cell reactivity in the brain without apparent neurological signs. In 6 of 11 patients with HIV infection, antibodies synthesized in the central nervous system were directed against HIV envelope proteins. Active viral expression appears to be necessary for both the immunodeficiency and progressive encephalopathy associated with HIV infection.
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Goudsmit J, Wolters EC, Bakker M, Smit L, Van der Noordaa J, Hische EA, Tutuarima JA, Van der Helm HJ. Intrathecal synthesis of antibodies to HTLV-III in patients without AIDS or AIDS related complex. BMJ 1986; 292:1231-4. [PMID: 3011184 PMCID: PMC1340242 DOI: 10.1136/bmj.292.6530.1231] [Citation(s) in RCA: 105] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
De novo synthesis in the central nervous system of IgG antibodies to human T cell lymphotropic virus type III (HTLV-III) (lymphadenopathy associated virus) was shown in seven of 10 seropositive men who had syphilis but not the acquired immune deficiency syndrome (AIDS) or AIDS related complex. None of these men showed neurological symptoms when the serum and cerebrospinal fluid were collected. Pleocytosis was present in all 10. Of the seven men who showed evidence of intrathecal synthesis of antibodies, five had increased total concentrations of IgG and four had oligoclonal IgG bands in their cerebrospinal fluid. Oligoclonal bands were also present in one man who did not have any antibodies. Longitudinal study of one man showed that seroconversion preceded intrathecal synthesis of antibody specific to HTLV-III. The appearance of antibody in the cerebrospinal fluid was accompanied by a transient rise in mononuclear cell count and the appearance of oligoclonal bands. The presence of clones of B cells specific to HTLV-III in the central nervous system of these patients without persisting neurological symptoms suggests that HTLV-III enters the central nervous system in the early stages of infection.
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