Incidence of varicella zoster virus infections of the central nervous system in the elderly: a large tertiary hospital-based series (2007–2014)

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 negative results who simultaneously presented herpes zoster and CSF or magnetic resonance imaging findings suggestive of CNS infection, and in whom other possible aetiologies had been ruled out. The study included 280 patients. The disease was considered to be caused by a VZV infection in 32 patients (11.4%), of which 23 cases were virologically confirmed (detection of VZV DNA in CSF). The most frequent diagnosis of the patients with VZV CNS infection was encephalitis (83.3%), followed by meningitis (13.3%) and cerebellitis (3.3%). The mean annual incidence of VZV CNS infection was 3.0 cases per 100,000 inhabitants. VZV was the most common cause of encephalitis and viral meningitis, ahead of herpes simplex virus (n = 9). At the time of discharge, 12 (40%) patients showed neurological sequelae. Five patients (20%) died during hospitalization, all with encephalitis. Patients with a fatal outcome had significantly higher median age and longer delay before initiating acyclovir. In conclusion, VZV was the first cause of encephalitis in our elderly population. Despite acyclovir treatment, there was a high rate of case fatality and sequelae at discharge.

Alpha herpes virus infections in a group of patients clinically suspected of central nervous system infections in Sri Lanka. A brief laboratory report

“…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.…”

“…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.…”

Varicella zoster encephalitis in an immunocompromised patient presented with migraine type headache: A case report

“…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.…”

A Rare Case of an Immunocompetent Male With Zoster Meningitis

“…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.…”