Abstract:The aim of the study was to describe the clinical and epidemiological characteristics of the central nervous system (CNS) infection by varicella zoster virus (VZV) in patients older than 65 years in a tertiary community hospital. We retrospectively analysed the results of cerebrospinal fluid (CSF) testing in patients older than 65 years between 2007 and 2014 with clinically suspected VZV infection with CNS involvement. Patients whose CSF samples were positive for VZV DNA were included, as were those with negat… Show more
“…Absence of the typical skin rash should therefore not exclude the possibility of VZV CNS infection. 1,3,4 There were two fatalities despite early and adequate treatment with intravenous aciclovir and both patients were considered as immunosuppressed. One patient was on long term steroid therapy for connective tissue disorder and the other patient had uncontrolled diabetes mellitus.…”
Section: Discussionmentioning
confidence: 99%
“…Alpha herpes viruses cause central nervous system (CNS) infections during primary infection or following reactivation from the latent state. [1][2][3][4][5] Patients with CNS infections develop a wide range of clinical features including headache, fever, seizures, altered behavior and altered level of consciousness though these may not be present in all patients. Clinical manifestations may be atypical, and diagnosis can be challenging.…”
This an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
“…Absence of the typical skin rash should therefore not exclude the possibility of VZV CNS infection. 1,3,4 There were two fatalities despite early and adequate treatment with intravenous aciclovir and both patients were considered as immunosuppressed. One patient was on long term steroid therapy for connective tissue disorder and the other patient had uncontrolled diabetes mellitus.…”
Section: Discussionmentioning
confidence: 99%
“…Alpha herpes viruses cause central nervous system (CNS) infections during primary infection or following reactivation from the latent state. [1][2][3][4][5] Patients with CNS infections develop a wide range of clinical features including headache, fever, seizures, altered behavior and altered level of consciousness though these may not be present in all patients. Clinical manifestations may be atypical, and diagnosis can be challenging.…”
This an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
“…VZV encephalitis is an uncommon complication of immunosuppressive treatment with mean annual incidence of 3 cases per 100,000 inhabitants [7]. Delayed diagnosis and treatment of VZV encephalitis in patients who presented with non-specific symptoms in the absence of skin lesions can have grave outcomes.…”
Varicella zoster virus (VZV) has been increasingly linked with encephalitis and atypical presentations in immunosuppressed patients. We present a patient with history of immunosuppressant intake for polymyositis who initially presented with throbbing frontal headache that raised the suspicion of migraine. She did not respond to anti-migraine medication and later developed stimulus induced myoclonus. She then had significant neurological decline and eventually became encephalopathic. Her initial imaging of brain was unremarkable which warranted further investigations. She was then diagnosed to be VZV positive in the cerebrospinal fluid (CSF) sample that confirmed VZV encephalitis. She responded well to IV Acyclovir treatment and her neurological function improved significantly. In this case, there was delay in diagnosis of VZV in the setting of immunosuppression and non-specific clinical presentation. Therefore, we encourage to strongly consider early VZV diagnostic work up and treatment in immunocompromised patients who can present with non-specific symptoms without a typical cutaneous rash.
“…A large tertiary hospital-based series studied the epidemiological characteristics of central nervous system (CNS) infection by VZV in patients older than 65 years of age and reported mean annual incidence of VZV CNS infection of 0.003%. 7 On literature review, only a handful of cases have been reported of VZV reactivation in immunocompetent patients, most of which involved adult or elderly patients. [8][9][10][11][12] For proper diagnosis, CSF analysis using molecular biology tests such as PCR-to detect viral particles is considered a cornerstone.…”
Section: Journal Of Investigative Medicine High Impact Case Reportsmentioning
Varicella zoster meningitis is an uncommon complication of herpes zoster, especially in immunocompetent patients. We report a case of a healthy 45-year-old male who developed aseptic meningitis as a result of reactivated varicella zoster virus infection. This case highlights the importance of remaining cognizant of varicella zoster virus as a cause of meningitis in not only the elderly or immunocompromised patients but also in patients who are healthy.
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