Acute central nervous system complications in varicella zoster virus infections.
BACKGROUND
In a previous multicenter study on central nervous system (CNS) viral infections varicella zoster virus (VZV) appeared the most frequent etiologic agent and appeared often without rash.


OBJECTIVE
To evaluate the appearance and diagnostics of VZV in CNS more thoroughly, we studied the cases systematically by using sensitive and specific methods to learn the best diagnostic approach in order to start specific therapy.


METHODS
We analyzed all serum and cerebrospinal fluid samples of 174 patients, 88 females and 86 males, with acute CNS symptoms associated with VZV infection diagnosed in the multicenter study on viral CNS infections.


RESULTS
About 38 patients (22%) had chickenpox, 59 (34%) had shingles, and 77 (44%) had no cutaneous symptoms at all. The mean age of chickenpox patients was 8.6 years, of the others 46.6 and 41.4 years. VZV-specific nucleic acid was detected in the CSF in one fourth of the patients in all groups, primarily during the first week of illness. In serum specimens, specific IgM was present in two thirds of the patients with chickenpox, whereas in the others in one third of the cases. In CSF, specific IgM was present in 15-17% of patients with skin manifestations, compared with 6% of those without rash.


CONCLUSIONS
The role of VZV infections in CNS complications seems remarkable, often presenting without rash. Even these cases should be promptly recognized in order to conduct proper antiviral therapy. In children, a combination of PCR and IgM tests is the best approach. In adults, PCR, together with the measurement of intrathecal antibody production yields best results.
Koskiniemi
Marjaleena
M
Department of Virology, Haartman Institute, Helenski University, Finland. marjaleena.koskiniemi@helsinki.fi
Piiparinen
Heli
H
Rantalaiho
Timo
T
Eränkö
Pekka
P
Färkkilä
Markus
M
Räihä
Kirsti
K
Salonen
Eeva Marjatta
EM
Ukkonen
Pentti
P
Vaheri
Antti
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis / Q000209:etiology*; D002644:Chickenpox / Q000150:complications*; D002648:Child; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D020804:Encephalitis, Varicella Zoster / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012871:Skin Diseases / Q000209:etiology
D000914:Antibodies, Viral; D004279:DNA, Viral