Varicella zoster virus-associated neurological disease in HIV-infected patients.
Varicella zoster virus (VZV) is an uncommon but well recognized cause of neurological disease in HIV-infected patients. Analysis of cerebrospinal fluid (CSF) using the polymerase chain reaction (PCR) in HIV-infected patients presenting with neurological disease has increasingly allowed diagnosis of VZV-associated pathology. We report clinical, radiological and virological data from 15 consecutive patients with VZV-associated neurological disease. Clinical presentation was varied, including meningo-encephalitis in 9 and isolated cranial nerve palsies in 6. VZV deoxyribonucleic acid (DNA) was detected by PCR in CSF of 11/15; pleocytosis was present in only 6/15, raised protein in 11/15. Magnetic resonance imaging (MRI) appearances were focal signal abnormalities in 8, meningeal enhancement in 2 and normal in 2. With specific anti-VZV therapy 10 patients recovered fully. The predictive value of PCR on CSF for diagnosis of VZV-associated neurological disease should take into account the patient's clinical presentation, concurrent infections and response to anti-VZV therapy.
Department of Sexually Transmitted Diseases, Windeyer Institute of Medical Sciences, Royal Free and University College Medical School, University College London, UK.
M
M
Brown
M
M
Scarborough
N
N
Brink
H
H
Manji
R
R
Miller
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002494:Central Nervous System Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology*; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006562:Herpes Zoster / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
D000998:Antiviral Agents; D004279:DNA, Viral