Acute meningoencephalomyelitis due to varicella-zoster virus in an AIDS patient: report of a case and review of the literature

Corti, Marcelo; Trione, Norberto; Villafañe, María F.; Risso, Daniel; Yampolsky, Claudio; Mamanna, Lilia

doi:10.1590/s0037-86822011000600026

Cited by 10 publications

(18 citation statements)

References 7 publications

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“…VZV has been isolated in the CSF of MS patients and has also been identified during MS flares [98][99][100]. A small number of case reports also note VZV infection in ADEM cases, with several reporting the presence of VZV in the CSF [101][102][103][104][105][106][107][108][109][110].…”

Section: Viruses Common In Adem and Msmentioning

confidence: 99%

Acute disseminated encephalomyelitis progressing to multiple sclerosis: Are infectious triggers involved?

et al. 2014

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Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are demyelinating disorders affecting the central nervous system. An autoimmune aetiology has been proposed for both. ADEM principally affects adolescents following acute infection by a variety of pathogens and has also been reported to occur following vaccination. ADEM typically resolves following medical treatment, whereas MS follows a more relapsing and remitting course. The pathogenesis of MS remains unclear, but it is thought that a combination of infectious and non-infectious environmental factors and host genetics act synergistically to cause disease. A variety of viruses, including Epstein Barr virus, cytomegalovirus, herpes simplex virus and varicella zoster virus, have been implicated as possible infectious triggers. The similar clinical and pathological presentation of ADEM and MS presents a diagnostic challenge for distinguishing ADEM from a first episode of MS. Some cases of ADEM progress to MS for reasons that are not currently clear. This review examines the evidence for infectious agents as triggers for ADEM progressing to MS and suggests potential methods that may facilitate identification of infectious agents that may be responsible for the pathogenesis of ADEM to MS.

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Section: Viruses Common In Adem and Msmentioning

confidence: 99%

Acute disseminated encephalomyelitis progressing to multiple sclerosis: Are infectious triggers involved?

et al. 2014

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“…Previous publications describe disseminated varicella in HIV-positive persons, including retinal necrosis and other central nervous involvement similar to the conditions described in our analysis. [ 29 – 31 ] Disseminated varicella after administration of varicella vaccine has also been described. [ 32 , 33 ] Antibody responses to PPSV23 can be lower in immunocompromised HIV-positive persons, [ 15 , 34 , 35 ] and this lower response has been associated with an increased risk of invasive pneumococcal disease.…”

Section: Discussionmentioning

confidence: 99%

Adverse events after vaccination among HIV-positive persons, 1990–2016

Lewis

et al. 2018

PLoS ONE

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Human immunodeficiency virus (HIV) causes immune dysregulation, potentially affecting response to vaccines in infected persons. We investigated if unexpected adverse events (AEs) or unusual patterns of AEs after vaccination were reported among HIV-positive persons. We searched for domestic reports among HIV-positive persons to the Vaccine Adverse Event Reporting System (VAERS) during 1990–2016. We analyzed reports by age group (<19 and ≥19 years), sex, serious or non-serious status, live vaccine type (live versus inactivated), AEs reported, and CD4 counts. Of 532,235 reports received, 353 (0.07%) described HIV-positive persons, of whom 67% were aged ≥19 years, and 57% were male; most reports (75%) were non-serious. The most commonly reported inactivated vaccines were pneumococcal polysaccharide (27%) and inactivated influenza (27%); the mostly reported common live virus vaccines were combination measles, mumps, and rubella (8%) and varicella (6%). Injection site reactions were commonly reported (39%). Of 67 reports with CD4 counts available, 41 (61%) described persons immunocompromised at time of vaccination (CD4 count <500 cells/mm3), and differed from overall reports only in that varicella was the most common live virus vaccine (4 reports). Of 22 reports describing failure to protect against infection, 6 described persons immunocompromised at time of vaccination, among whom varicella vaccine was most common (3 reports). Of 66 reports describing live virus vaccines, 7 described persons with disseminated infection: 6 had disseminated varicella, 3 of whom had vaccine strain varicella-zoster virus. Of 18 reported deaths, 7 resulted from disseminated infection: 6 were among immunocompromised persons, 1 of whom had vaccine strain varicella-zoster virus. We identified no unexpected or unusual patterns of AEs among HIV-positive persons. These data reinforce current vaccine recommendations for this risk group. However, healthcare providers should know their HIV-positive patients’ immune status because immunocompromising conditions can potentially increase the risk of rare, but severe, AEs following vaccination with live virus vaccines.

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“…Clinical manifestations include diffuse meningoencephalitis, focal encephalitis and meningoencephalomyelitis. VZV myelitis, as the only manifestation of the disease, is rare and occurs in less than 1/1000 cases 2 .…”

Section: Discussionmentioning

confidence: 99%

“…This very sensitive and specific technique has overwhelmed the serological diagnosis of neuroherpeviruses infections in CSF 1 . Amplification of VZV DNA in CSF by PCR is the gold standard method in diagnosis of the clinical spectrum of neurological disorders associated with herpesvirus 2 , 10 . When the CSF sample is taken within the first few days after the onset of neurological symptoms, the rate of PCR positive is higher than afterwards 1 , 3 .…”

Section: Discussionmentioning

confidence: 99%

Meningoencephalitis Due to Varicella Zoster Virus in Aids Patients. Report of Eleven Cases and Review of the Literature

Corti

Villafañe

Vittar

et al. 2015

Rev. Inst. Med. trop. S. Paulo

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Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.

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Acute meningoencephalomyelitis due to varicella-zoster virus in an AIDS patient: report of a case and review of the literature

Cited by 10 publications

References 7 publications

Acute disseminated encephalomyelitis progressing to multiple sclerosis: Are infectious triggers involved?

Acute disseminated encephalomyelitis progressing to multiple sclerosis: Are infectious triggers involved?

Adverse events after vaccination among HIV-positive persons, 1990–2016

Meningoencephalitis Due to Varicella Zoster Virus in Aids Patients. Report of Eleven Cases and Review of the Literature

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