Features of varicella zoster virus myelitis and dependence on immune status

Hung, Chao Hung; Chang, Kuo‐Hsuan; Kuo, Hung‐Chou; Huang, Chi‐Chang; Liao, Ming‐Feng; Tsai, Yu-Tai; Ro, Long‐Sun

doi:10.1016/j.jns.2012.04.017

Cited by 52 publications

(55 citation statements)

References 33 publications

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“…Myelitis is more common in immunocompromised patients than in immunocompetent ones and can occur in conjunction with encephalitis and other neurological complications [60,61]. …”

Section: Myelitismentioning

confidence: 99%

“…Ramsay Hunt syndrome might manifest as abnormalities in the 7th and 8th cranial nerves [112,105]. Myelitis is associated with lesions on neuroimaging in the majority of patients [61]. Meningitis and radiculitis may co-exist with vasculopathy [89], but neuroimaging changes are not reported.…”

Section: Neuroimaging and Angiographic Featuresmentioning

confidence: 99%

“…The immunocompromised patients (17 of 31 patients) had a poorer outcome, with disability or death. Mortality rate was reported to be 23% and only affected immunocompromised patients, some with co-existing opportunistic infections[61].…”

mentioning

confidence: 99%

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Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment

Grahn

Studahl

2015

Journal of Infection

139

116

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“…Myelitis is more common in immunocompromised patients than in immunocompetent ones and can occur in conjunction with encephalitis and other neurological complications [60,61]. …”

Section: Myelitismentioning

confidence: 99%

Section: Neuroimaging and Angiographic Featuresmentioning

confidence: 99%

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Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment

Grahn

Studahl

2015

Journal of Infection

139

116

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“…Interestingly, many cases of VZV CNS disease prior to 1995 presented without an accompanying rash [6]. In a recent retrospective study comparing the clinical features of VZV myelitis in immunocompromised versus immunocompetent hosts, the immunocompetent patients were more likely to develop a myelopathy in the absence of rash [7]. With the advent of PCR and immunoassays over the past 15 years, neurologic complications of VZV infection are more frequently recognized.…”

Section: Discussionmentioning

confidence: 99%

Extensive VZV Encephalomyelitis without Rash in an Elderly Man

Lynch

Agarwal

Paranandi

et al. 2014

Case Reports in Neurological Medicine

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Introduction. Varicella zoster virus (VZV) encephalomyelitis with cranial nerve involvement is rare. Characteristically it is preceded by a rash and primarily presents in the immunocompromised. The spectrum of VZV neurologic disease is extensive and it is not uncommon to present without rash. We report the case of an elderly otherwise immunocompetent patient who presented with diverse manifestations of VZV CNS infection all occurring without rash. Case Report. A 78-year-old man presented with 1 week of progressive paraparesis and sensory loss, malaise, and fevers. MRI of the neuraxis demonstrated numerous enhancing lesions: intramedullary, leptomeningeal, pachymeningeal, and cranial nerves. Cerebrospinal fluid (CSF) showed a white blood cell count of 420/μL with elevated protein (385 mg/dL). CSF VZV qualitative PCR was positive and CSF VZV immunofluorescence assay detected IgM antibody, confirming the diagnosis of VZV encephalomyelitis. Clinical and radiological improvement was observed after intravenous acyclovir treatment. Conclusion. This is a rare report of an immunocompetent patient with extensive VZV encephalomyelitis. We highlight the importance of considering this diagnosis even in the absence of the characteristic rash, and the potential risk of premature discontinuation of antiviral therapy once HSV has been excluded. Prompt recognition and treatment can dramatically reduce morbidity and mortality in patients.

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“…22 There are several Hz-associated neurologic complications, such as PHN, meningitis, meningoencephalitis, cerebellitis, isolated cranial nerve palsies, that produce ophthalmoplegia or the Ramsay Hunt syndrome, Bell's palsy, multiple cranial nerve palsies (polyneuritis cranialis), vasculopathy, myelitis, acute disseminated encephalomyelitis, acute inflammatory demyelinating polyneuropathy (Guillain-Barré syndrome), focal motor weakness, and various inflammatory disorders of the eye, the most serious of which is acute retinal necrosis ( Table 2). [23][24][25][26][27][28][29] Subclinical invasion of VZV into the CNS is relatively common; approximately one third and 46% of neurologically asymptomatic immunocompetent individuals with cutaneous Hz have a cerebrospinal fluid (CSF) polymerase chain reaction test result that is positive for VZV and CSF leukocytosis, respectively. 30 Post-herpetic neuropathy, the most common complication of Hz, is defined as a neuropathic pain that persists for .…”

Section: Introductionmentioning

confidence: 99%

Herpes Zoster: Diagnostic, Therapeutic, and Preventive Approaches

Bader

2013

Postgraduate Medicine

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Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. Treatment of Hz includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. Herpes zoster has been associated with several complications, of which post-herpetic neuralgia (PHN) is the most common and debilitating. Varicella-zoster virus vaccine and early treatment with either famciclovir or valacyclovir are the only measures proven to prevent PHN. The options for treating PHN include topical agents, such as lidocaine patches, and systemic agents, such as the anticonvulsants gabapentin and pregabalin. Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.

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Features of varicella zoster virus myelitis and dependence on immune status

Cited by 52 publications

References 33 publications

Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment

Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment

Extensive VZV Encephalomyelitis without Rash in an Elderly Man

Herpes Zoster: Diagnostic, Therapeutic, and Preventive Approaches

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