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Drăgoi AL, Nemeș RM. A unique case of double meningitis with enterovirus and reactivated varicella-zoster virus in a male teenager. Diagn Microbiol Infect Dis 2024; 110:116409. [PMID: 38964071 DOI: 10.1016/j.diagmicrobio.2024.116409] [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] [Received: 06/02/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
This paper presents a unique case of double meningitis with enterovirus and reactivated varicella-zoster virus without shingles in an immunocompetent male teenager, a case that offers many important medical lessons, all "gravitating" around physiopathological reasoning of any clinical case in general.
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Affiliation(s)
- Andrei-Lucian Drăgoi
- The Medical Doctoral School of University "Titu Maiorescu", Bucharest, Romania; The Emergency County Hospital Târgoviște (Romania) (SJUT), Street General Ion Emanoil Florescu, nr. 9, bl. D11, sc. B, ap. 9 (2nd floor), Targoviste, Dambovita county, Romania, 130056.
| | - Roxana-Maria Nemeș
- Medical Doctoral School of University "Titu Maiorescu", Bucharest, Romania; Institute of Pneumophthisiology "Marius Nasta", Bucharest, Romania
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2
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Kerr C, O’Neill S, Szucs A, Darmody O, Williamson C, Bannan C, Merry C. Zoster meningitis in an immunocompetent young patient post first dose of BNT162b2 mRNA COVID-19 vaccine, a Case Report. IDCases 2022; 27:e01452. [PMID: 35186672 PMCID: PMC8837498 DOI: 10.1016/j.idcr.2022.e01452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 12/30/2022] Open
Abstract
Recently published observational data suggests an increased risk of herpes zoster infection post-vaccination with the BNT162b2 mRNA vaccine. We describe the case of VZV meningitis post BNT162b2 mRNA vaccination in a young immunocompetent patient. A 39-year-old patient with no medical history presented with a vesicular rash, headache, nausea and fever, days after receiving BNT162b2 mRNA vaccination. CSF analysis revealed a pleocytosis, and VZV DNA was confirmed by PCR testing. The patient received intravenous aciclovir with resolution of symptoms within 48 h. He was discharged after 14 days of treatment. Case reports of herpes zoster reactivation post vaccination and details of subsequent successful vaccination course completion have allowed us to recommend the patient receive his second dose of the BNT162b2 mRNA vaccine. At the time of writing, however, the patient has declined to receive further vaccination due to fears of an adverse event. To the best of our knowledge, this is the first reported case in a young patient of herpes zoster meningitis following COVID-19 mRNA vaccination. The sharing of clinical experiences and reporting of suspected side effects, particularly for vaccines that employ novel technology, increases knowledge of the safety profile of these vaccines and allows clinicians to better aid patients make informed decisions with regard to commencing and completing vaccination.
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3
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Varicella Zoster Virus Meningitis with Absence of Rash in an Immunocompetent Child. Case Rep Med 2021; 2021:2081270. [PMID: 34630570 PMCID: PMC8497137 DOI: 10.1155/2021/2081270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Only a few cases in the literature have ever reported the reactivation of the varicella zoster virus (VZV) in children especially in the case of immunocompetent patients. It is an uncommon situation that may lead to several neurological complications. We report varicella zoster virus (VZV) meningitis in a 14-year-old healthy boy with no antecedent of rash. On his cerebrospinal fluid (CSF) examination, VZV DNA was detected. The rapid HIV test was negative. The treatment using acyclovir (20 mg/kg/8h) was effective, and the child's clinical condition rapidly improved.
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4
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Update on Viral Infections Involving the Central Nervous System in Pediatric Patients. CHILDREN-BASEL 2021; 8:children8090782. [PMID: 34572214 PMCID: PMC8470393 DOI: 10.3390/children8090782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022]
Abstract
Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.
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Shang BS, Hung CJJ, Lue KH. Herpes Zoster in an Immunocompetent Child without a History of Varicella. Pediatr Rep 2021; 13:162-167. [PMID: 33916031 PMCID: PMC8167658 DOI: 10.3390/pediatric13020022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
Herpes zoster is a relatively rare infectious disease in the pediatric population, as compared with adults, which is due to the reactivation of latent Varicella-Zoster virus. We report a 7-year-old child without any history of varicella, who first experienced skin pain and later presented skin lesions in dermatomal distribution. Finally, the patient was diagnosed with herpes zoster. We aim to emphasize that herpes zoster could occur in immunocompetent children and may be due to the reactivation of the vaccine strain or previous subclinical infection.
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Affiliation(s)
- Bing-Shiau Shang
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung City 402, Taiwan;
- Department of Medicine, Chung Shan Medical University, Taichung City 402, Taiwan;
| | - Cheng-Jui Jamie Hung
- Department of Medicine, Chung Shan Medical University, Taichung City 402, Taiwan;
| | - Ko-Huang Lue
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung City 402, Taiwan;
- Department of Medicine, Chung Shan Medical University, Taichung City 402, Taiwan;
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6
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Mroue L, Brar H, Gonik B. Varicella zoster meningitis in a pregnant woman with uncontrolled type 1 diabetes mellitus. BMJ Case Rep 2021; 14:14/2/e236644. [PMID: 33622740 PMCID: PMC7907841 DOI: 10.1136/bcr-2020-236644] [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: 11/03/2022] Open
Abstract
We report the case of retrograde varicella zoster virus (VZV) reactivation presenting as aseptic meningitis without rash in a generally healthy pregnant patient. A 27-year-old nulliparous woman at 25 weeks of gestation presented to the emergency department with a 1-day history of severe headache associated with nausea, photophobia and neck stiffness. After ruling out a space-occupying lesion by brain imaging, lumbar puncture was performed. Cerebrospinal fluid analysis by PCR revealed the presence of VZV, making the diagnosis of acute varicella meningitis. The patient had immunoglobulin studies consistent with a history of primary VZV infection, thus confirming reactivation of VZV rather than primary infection. The patient was treated with acyclovir for 14 days and recovered fully. Her neonate was delivered full term without any evidence of vertical transmission. This is only the second reported case of VZV meningitis in a pregnant patient in the medical literature, and the first case in the US that was reported.
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Affiliation(s)
- Laura Mroue
- Obstetrics-Gynecology, Detroit Medical Center, Detroit, Michigan, USA
| | - Harpreet Brar
- Obstetrics-Gynecology, Detroit Medical Center, Hamtramck, Michigan, USA
| | - Bernard Gonik
- Obstetrics-Gynecology, Detroit Medical Center, Detroit, Michigan, USA
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Lee S, Ojaimi S, Lai CL, Smith J, Kyprianou K. REACTIVATION VARICELLA ZOSTER MENINGOENCEPHALITIS AND SINUSITIS IN A SEEMINGLY IMMUNOCOMPETENT ADOLESCENT. J Paediatr Child Health 2021; 57:307. [PMID: 33600627 DOI: 10.1111/jpc.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Stephanie Lee
- Department of General Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Samar Ojaimi
- Department of General Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Chui L Lai
- Monash University, Clayton, Victoria, Australia
| | - Julia Smith
- Department of General Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Kypros Kyprianou
- Department of General Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia.,Monash University, Clayton, Victoria, Australia
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Amaral V, Shi JZ, Tsang AMC, Chiu SSS. Primary varicella zoster infection compared to varicella vaccine reactivation associated meningitis in immunocompetent children. J Paediatr Child Health 2021; 57:19-25. [PMID: 33295075 DOI: 10.1111/jpc.15303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/30/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
We diagnosed varicella zoster virus (VZV) meningitis in a healthy adolescent boy who presented without a rash or fever. We aim to compare VZV reactivation meningitis in children after primary VZV infection and VZV vaccination. We reviewed the literature up until June 2020 using Pubmed/MEDLINE and EMBASE databases using 'varicella zoster', 'meningitis' and 'children' as keywords. Only English articles were included. Twenty-five cases were included in this review. Children who had VZV reactivation meningitis after vaccination were younger (7 ± 3.4 years vs. 11.9 ± 3.6 years, P = 0.0038), had a shorter interval between first exposure to reactivation (5.6 ± 2.9 years vs. 8.8 ± 3.2 years, P = 0.018) and more likely to have a rash (100% vs. 55%, P = 0.04). VZV reactivation meningitis occurs after both primary VZV infection and VZV vaccination. The absence of exanthem, fever or meningism does not rule out VZV meningitis.
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Affiliation(s)
- Vanessa Amaral
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Julia Zhuo Shi
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Anita Man-Ching Tsang
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Susan Shui-Seng Chiu
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Ciancia S, Crisafi A, Fontana I, De Fanti A, Amarri S, Iughetti L. Encephalitis due to herpes zoster without rash in an immunocompetent 12-year-old girl: case report and review of the literature. BMC Pediatr 2020; 20:348. [PMID: 32682414 PMCID: PMC7368762 DOI: 10.1186/s12887-020-02244-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022] Open
Abstract
Background Neurological complications due to reactivation of varicella-zoster virus (VZV) are very uncommon in immunocompetent patients. Generally a vesicular rash is present on one or more dermatomes, preceding or following the main manifestation. Few cases are reported in the international literature, but they concern mainly adult or elderly patients. Case presentation A 12-year-old girl was referred to our hospital for persisting headache, cough and rhinitis for six days. After first examination, diagnosis of anterior sinusitis was made by nasal endoscopy. The day after, the girl developed psychotic symptoms and altered mental status. Computed tomography (CT) scan was immediately performed but was unremarkable; lumbar puncture revealed leukocytosis with lymphocytic predominance and cerebrospinal fluid polymerase chain reaction (PCR) detected varicella-zoster virus DNA. The diagnosis of acute VZV encephalitis was made. The patient was promptly treated with acyclovir infused intravenously and her clinical conditions rapidly improved. Tests made did not show any condition of immunosuppression. Conclusions Although if rare, reactivation of VZV can occur in immunocompetent children and its complications can involve central nervous system. Among these complications, meningitis is more common, but cerebral parenchyma can also be involved leading to a severe medical condition that is defined meningoencephalitis. In rare cases vesicular rash may be absent; therefore high level of suspicion is required even in those patients in which suggestive clinical features are not present to guide the diagnosis. Intravenous acyclovir represents the treatment of choice to obtain a fast clinical response and to prevent the onset of late-term complications.
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Affiliation(s)
- Silvia Ciancia
- Post-graduated School of Pediatrics, Department of Medical and Surgical Sciences for Mother, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Antonella Crisafi
- Pediatrics Unit, Arcispedale Santa Maria Nuova, via Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Ilaria Fontana
- Pediatrics Unit, Arcispedale Santa Maria Nuova, via Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Alessandro De Fanti
- Pediatrics Unit, Arcispedale Santa Maria Nuova, via Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Sergio Amarri
- Pediatrics Unit, Arcispedale Santa Maria Nuova, via Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Lorenzo Iughetti
- Post-graduated School of Pediatrics, Department of Medical and Surgical Sciences for Mother, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy. .,Pediatrics Unit, Department of Medical and Surgical Sciences for Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
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10
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Rice JK, Kabrhel C, Wittels K, Wilcox SR. Concern for a Classic Sexually Transmitted Infection. J Emerg Med 2019; 58:330-333. [PMID: 31818609 DOI: 10.1016/j.jemermed.2019.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Justin Keith Rice
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christopher Kabrhel
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen Wittels
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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11
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Yasuda R, Minami K, Ogawa A, Okada H, Terakawa R, Koike Y, Ogura S, Takeuchi K, Higuchi T. Herpes zoster and meningitis in an immunocompetent child: a case report. J Med Case Rep 2019; 13:182. [PMID: 31200772 PMCID: PMC6570968 DOI: 10.1186/s13256-019-2082-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/12/2019] [Indexed: 12/18/2022] Open
Abstract
Background Development of neurological complications of varicella zoster virus reactivation is relatively uncommon, particularly in an immunocompetent child. Case presentation An 11-year-old Asian girl presented with headache and skin rash on her left chest. She was diagnosed with meningitis, and herpes zoster was confirmed by polymerase chain reaction using cerebrospinal fluid. Acyclovir was administered intravenously. Given the favorable evolution of the clinical course, she was discharged from the hospital on day 8 of her illness. She had no apparent sequelae or comorbidities at the time of the 6-week follow-up. Conclusions Neurological complications such as meningitis due to varicella zoster virus reactivation are uncommon, especially in an immunocompetent child; no specific immune deficiency was identified in our patient. We conclude that, although rare, varicella zoster virus should be recognized as a potential cause of viral meningitis in immunocompetent children.
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Affiliation(s)
- Ryu Yasuda
- Department of General Pediatrics, Nagano Children's Hospital, Nagano, Japan. .,Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Kisei Minami
- Department of General Pediatrics, Nagano Children's Hospital, Nagano, Japan
| | - Akira Ogawa
- Department of General Pediatrics, Nagano Children's Hospital, Nagano, Japan
| | - Hideshi Okada
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Runa Terakawa
- Department of General Pediatrics, Nagano Children's Hospital, Nagano, Japan
| | - Yumi Koike
- Department of General Pediatrics, Nagano Children's Hospital, Nagano, Japan
| | - Shinji Ogura
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kouichi Takeuchi
- Department of General Pediatrics, Nagano Children's Hospital, Nagano, Japan
| | - Tsukasa Higuchi
- Department of General Pediatrics, Nagano Children's Hospital, Nagano, Japan
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12
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Gnoni M, Zaheer K, Vasser MM, Singh M, Ajmeri A, Harter SR, Mughees Rana A, Aguilar R. Varicella Zoster aseptic meningitis: Report of an atypical case in an immunocompetent patient treated with oral valacyclovir. IDCases 2018; 13:e00446. [PMID: 30167375 PMCID: PMC6115539 DOI: 10.1016/j.idcr.2018.e00446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022] Open
Abstract
Varicella Zoster when described has the typical presentation of a dermatomal distribution of a rash and can further lead to CNS complications. This can be treated accordingly with the proper protocol, but if the presentation is atypical and the protocol is challenged or changed per specific patient outcomes, new developments can occur. Here we present a case of a 29-year-old Caucasian female that presented to the emergency department with headache, photophobia, and chills for 5 days. She was previously healthy and immunocompetent; CSF PCR analysis revealed a VZV infection causing acute aseptic meningitis with no shingles rash eruption on physical examination. The patient was not willing to stay hospitalized for the duration of the treatment. This gave us an opportunity to treat her with an oral, rather than IV, antiviral. The patient was successfully treated with oral valacyclovir 2 g Q6H after only receiving two days of IV acyclovir. To the best of our knowledge, this is the first reported case of a patient with VZV-associated meningitis successfully treated with oral valacyclovir.
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Affiliation(s)
- Martin Gnoni
- Our Lady of Bellefonte Hospital, 1000 St Christopher Dr, Ashland, KY 41101, United States
| | - Kamran Zaheer
- Our Lady of Bellefonte Hospital, 1000 St Christopher Dr, Ashland, KY 41101, United States
| | - Melinda M Vasser
- Our Lady of Bellefonte Hospital, 1000 St Christopher Dr, Ashland, KY 41101, United States
| | - Monider Singh
- Marshall University, MU Internal Medicine Residency Program, 1249 15th Street, Huntington, WV 25701, United States
| | - Aman Ajmeri
- Marshall University, MU Internal Medicine Residency Program, 1249 15th Street, Huntington, WV 25701, United States
| | - Stephanie R Harter
- Marshall University, MU Internal Medicine Residency Program, 1249 15th Street, Huntington, WV 25701, United States
| | - Abdul Mughees Rana
- Marshall University, MU Internal Medicine Residency Program, 1249 15th Street, Huntington, WV 25701, United States
| | - Rodrigo Aguilar
- Marshall University, MU Internal Medicine Residency Program, 1249 15th Street, Huntington, WV 25701, United States
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Luisier V, Weber L, Fishman D, Praz G, Ghika JA, Genoud D, Chabwine JN. Definition and management of varicella zoster virus-associated meningoradiculitis: a case report. BMC Res Notes 2016; 9:451. [PMID: 27670683 PMCID: PMC5037650 DOI: 10.1186/s13104-016-2257-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The varicella zoster virus affects the central or peripheral nervous systems upon reactivation, especially when cell-mediated immunity is impaired. Among varicella zoster virus-related neurological syndromes, meningoradiculitis is an ill-defined condition for which clear management guidelines are still lacking. Zoster paresis is usually considered to be a varicella zoster virus-peripheral nervous system complication and treated with oral antiviral therapy. Yet in the literature, the few reported cases of herpes zoster with mild cerebral spinal fluid inflammation were all considered meningoradiculitis and treated using intravenous antiviral drugs, despite absence of systemic signs of meningitis. Nevertheless, these two clinical pictures are very similar. Case presentation We report the case of an alcohol-dependent elderly Caucasian man presenting with left lower limb zoster paresis and mild cerebral spinal fluid inflammation, with favorable outcome upon IV antiviral treatment. We discuss interpretation of liquor inflammation in the absence of clinical meningitis and implications for the antiviral treatment route. Conclusion From this case report we suggest that varicella zoster virus-associated meningoradiculitis should necessarily include meningitis symptoms with the peripheral neurological deficits and cerebral spinal fluid inflammation, requiring intravenous antiviral treatment. In the absence of (cell-mediated) immunosuppression, isolated zoster paresis does not necessitate spinal tap or intravenous antiviral therapy.
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Affiliation(s)
- Vincent Luisier
- Internal Medicine Division, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Lalensia Weber
- Internal Medicine Division, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Daniel Fishman
- Emergency Department, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Gérard Praz
- Infectious Disease Division (Central Institute), Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Joseph-André Ghika
- Division of Neurology, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Didier Genoud
- Division of Neurology, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland
| | - Joelle Nsimire Chabwine
- Division of Neurology, Valais Hospital, Avenue Grand Champsec, 80, 1951, Sion, Switzerland. .,Neurology Unit, Department of Medicine, Faculty of Sciences, University of Fribourg, Chemin du Musée 5, 1700, Fribourg, Switzerland.
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14
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Akya A, Ahmadi K, Zehtabian S, Salimi A, Elahi A, Madani SH. Study of the Frequency of Herpesvirus Infections Among Patients Suspected Aseptic Meningitis in the West of Iran. Jundishapur J Microbiol 2015; 8:e22639. [PMID: 26568804 PMCID: PMC4641434 DOI: 10.5812/jjm.22639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/12/2015] [Accepted: 02/14/2015] [Indexed: 12/18/2022] Open
Abstract
Background: Aseptic meningitis is the most common type of meningitis and is characterized by meningeal inflammation that is not linked to identifiable bacterial pathogens in cerebrospinal fluid (CSF). Objectives: This study aimed to evaluate the frequency of aseptic meningitis caused by herpesviruses, namely herpes simplex types I and II (HSV-1, HSV-2), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and varicella-zoster virus (VZV). Patients and Methods: A total of 196 CSF samples were collected from patients with suspected meningitis. All samples were smear- and culture-negative for bacterial pathogens. The biochemical and cytological findings of CSF samples were also recorded. DNA was extracted from samples and PCR with specific primers was carried out to detect viruses. Results: The 196 samples derived from 100 (52%) men and 96 (48%) women ranging in age from one day to 86 years with an average age of 32.3 ± 25.3 years. Of them, 8 (4.08%) samples yielded positive results, including 5 (2.55%) cases of VZV infection and 3 (1.53%) cases of HSV-1 infection. No cases of HSV-2, CMV or EBV infection were detected. CSF protein and glucose levels among positive cases were all in the normal range. Conclusions: The results indicate a considerable rate of herpesvirus infection in patients with aseptic meningitis, and that VZV is the most common herpesvirus to cause infection followed by HSV-1. Our results also showed that a moderate increase in the WBC count and predominance of lymphocytes can be valuable clues in diagnosing viral meningitis. Given the different approaches of drug therapy in bacterial and viral meningitis, use of molecular methods is necessary in hospitals to rapidly discriminate between them.
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Affiliation(s)
- Alisha Akya
- Nosocomial Infection Research Centre, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding author: Alisha Akya, Nosocomial Infection Research Centre, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-8334274618, Fax: +98-8334276477, E-mail:
| | - Kamal Ahmadi
- MSc Student of Medical Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Shahram Zehtabian
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Afsaneh Salimi
- MSc Student of Medical Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Azam Elahi
- MSc Student of Medical Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Sayed Hamid Madani
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
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Galetta KM, Gilden D. Zeroing in on zoster: A tale of many disorders produced by one virus. J Neurol Sci 2015; 358:38-45. [PMID: 26454371 PMCID: PMC4628852 DOI: 10.1016/j.jns.2015.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 12/21/2022]
Abstract
While herpes zoster infection has been recognized since antiquity, chickenpox (varicella) was confused with smallpox until the 1800s, when both illnesses became better understood. In the 20th century, varicella zoster virus (VZV) was shown to cause varicella upon primary (first-time) infection and herpes zoster (shingles) after reactivation of latent VZV. Scientific progress over the past 50 years has rapidly advanced the understanding and prevention of disease produced by VZV. Combined imaging and virological studies continue to reveal the protean neurological, ocular and visceral disorders produced by VZV.
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Affiliation(s)
- Kristin M Galetta
- Department of Neurology, Brigham and Women's Hospital, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Don Gilden
- Departments of Neurology and Immunology & Microbiology, University of Colorado School of Medicine, Aurora, CO, USA.
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Science M, MacGregor D, Richardson SE, Mahant S, Tran D, Bitnun A. Central nervous system complications of varicella-zoster virus. J Pediatr 2014; 165:779-85. [PMID: 25063723 DOI: 10.1016/j.jpeds.2014.06.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/14/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe the spectrum of central nervous system complications of varicella-zoster virus (VZV) in children admitted to The Hospital for Sick Children between January 1999 and December 2012. STUDY DESIGN Children aged 1 month to 18 years (n = 84) admitted with neurologic manifestations associated with a characteristic VZV rash or a confirmatory laboratory test (positive lesion scraping or cerebrospinal fluid polymerase chain reaction) were included in the study. Acute neurologic complications were included if they occurred within 4 weeks of VZV infection. Stroke was considered related to VZV if it occurred within 6 months of VZV infection, the neuroimaging was characteristic, and other causes were excluded. RESULTS Clinical syndromes included acute cerebellar ataxia (n = 26), encephalitis (n = 17), isolated seizures (n = 16), stroke (n = 10), meningitis (n = 10), Guillain-Barré syndrome (n = 2), acute disseminated encephalomyelitis (n = 2), and Ramsay Hunt syndrome (n = 1). In those with acute complications (nonstroke), neurologic symptoms occurred a median of 5 days after rash onset (range -6 to +16). The time between rash onset and stroke ranged from 2 weeks to 26 weeks (median 16.0 weeks). Three children with encephalitis died. Residual neurologic sequelae at one year occurred in 9 of 39 (23%) of children with follow-up data. Only 4 children were reported to have received the varicella vaccine. CONCLUSION Neurologic complications of VZV infection continue to occur despite the availability of an effective vaccine. Neurologic symptom onset can predate the appearance of the VZV exanthem and in rare cases may occur in the absence of an exanthem.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daune MacGregor
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan E Richardson
- Division of Microbiology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dat Tran
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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Caffarelli C, Santamaria F, Vottero A, Dascola CP, Mirra V, Sperli F, Bernasconi S. Progress in pediatrics in 2013: choices in allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses. Ital J Pediatr 2014; 40:62. [PMID: 25015124 PMCID: PMC4106226 DOI: 10.1186/1824-7288-40-62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 12/30/2022] Open
Abstract
This review will provide new information related to pathophysiology and management of specific diseases that have been addressed by selected articles published in the Italian Journal of Pediatrics in 2013, focusing on allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses in children. Recommendations for interpretation of skin prick test to foods in atopic eczema, management of allergic conjunctivitis, hypertension and breastfeeding in women treated with antiepileptic drugs and healthy breakfast have been reported. Epidemiological studies have given emphasis to high incidence of autoimmune disorders in patients with Turner syndrome, increasing prevalence of celiac disease, frequency of hypertension in adolescents, incidence and risk factor for retinopathy of prematurity. Advances in prevention include elucidation of the role of probiotics in reducing occurrence of allergies and feeding intolerance, and events of foetal life that influence later onset of diseases. Mechanistic studies suggested a role for vitamin D deficiency in asthma and type 1 diabetes and for reactivation of Varicella-Zoster virus in aseptic meningitis. Regarding diagnosis, a new mean for the diagnosis of hyperbilirubinaemia in newborns, a score for recognition of impaired nutritional status and growth and criteria for early Dyke-Davidoff-Masson Syndrome have been suggested. New therapeutic approaches consist of use of etanercept for reducing insulin dose in type 1 diabetes, probiotics in atopic eczema, and melatonin in viral infections.
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Affiliation(s)
- Carlo Caffarelli
- Department of Clinical and Experimental Medicine, Clinica Pediatrica, University of Parma, Parma, Italy.
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