Detection of varicella-zoster virus DNA in peripheral mononuclear cells from patients with Ramsay Hunt syndrome or zoster sine herpete

Abstract

On the basis of alterations in varicella-zoster virus (VZV) antibody titers, it appears that Bell's palsy in some patients could be associated with VZV reactivation, that is, zoster sine herpete. To obtain stronger evidence of this association, polymerase chain reaction (PCR) was used to detect VZV DNA in auricular lesions or peripheral blood mononuclear cells (PBMCs) from Bell's palsy or Ramsay Hunt syndrome patients. VZV DNA was detected in the auricular lesions of Ramsay Hunt syndrome, in PBMCs from 2 Ramsay Hunt syndrome patients, and in 4 of 17 samples from 16 Bell's palsy patients. Three of these four positive patients were thought to have zoster sine herpete because of hearing difficulty, vertigo, and pain. VZV IgM antibodies were positive in 1 of the 2 patients with Ramsay Hunt syndrome, and in 2 of the 17 samples from the Bell's palsy patients. VZV IgG antibody titers during the acute phase were significantly higher in the patients positive for the PCR or VZV IgM antibody than in those negative for them. These findings provide evidence that Bell's palsy in some patients could be associated with VZV reactivation.

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

“…Other rare complications include jugular foramen syndrome [440] and non-facial neuromotor deficits [441]. In addition to Ramsay Hunt syndrome, zoster sine herpete is increasingly recognised as a major aetiologic factor in idiopathic Bell’s palsy [442–444] and Ménière's disease [445, 446]. …”

Reactivation of type 1 herpes simplex virus and varicella zoster virus in an immunosuppressed patient with acute peripheral facial weakness

“…Furthermore, in 6 of 32 (19%) patients with isolated peripheral facial palsy who had a 4-fold rise in serum antibody to VZV, geniculate zone skin scrapings from 4 of those 6 patients were positive for VZV DNA [8]. Terada et al [9] also found that blood MNCs from 4 of 17 “Bell's palsy” patients were positive for VZV DNA. Although VZV DNA was not found in our patient's saliva, again most likely because saliva was not sampled until one month after the onset of facial palsy, early examination of saliva found VZV DNA in 20% of 10 [10] and 33% of 30 patients [11] with idiopathic peripheral facial palsy.…”

Varicella-zoster

“…Importantly, multiple forms of trigeminal (Easton, 1970; Hevner et al, 2003; Yamada et al, 2003) and facial (Morgan and Nathwani, 1992; Murakami et al, 1998; Terada et al, 1998) distribution zoster as well as polyneuritis cranialis due to VZV (Osaki et al, 1995; Murata et al, 2010) may occur in the absence of rash.…”

“…The inflammatory response in ganglia of these subjects raised the possibility of prolonged viral infection. Further evidence that PHN may be produced by low-level ganglionitis has come from the detection of VZV DNA and proteins in blood MNCs of many patients with PHN (Vafai et al, 1988; Devlin et al, 1992; Mahalingam et al, 1995) and from the favorable response of some PHN patients to antiviral treatment (Terada et al, 1998; Gilden et al, 2003). …”