Infections of the Nervous System Caused by Varicella-Zoster Virus: A Review

Echevarría, J M; Casas, Inmaculada; Martinez‐Martín, Pablo

doi:10.1159/000150535

Cited by 75 publications

(46 citation statements)

References 78 publications

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“…More frequently CNS involvement occurs as a result of ADEM, a postinfectious, immune-mediated, predominantly demyelinating process. Both the direct and immune-mediated CNS effects of varicella need to be distinguished from Reye's syndrome (74,75).…”

Section: Viruses For Which Pcr Has Potential Efficacy In Diagnosis Bumentioning

confidence: 99%

Molecular Methods for Diagnosis of Viral Encephalitis

2004

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Hundreds of viruses cause central nervous system (CNS) disease, including meningoencephalitis and postinfectious encephalomyelitis, in humans. The cerebrospinal fluid (CSF) is abnormal in >90% of cases; however, routine CSF studies only rarely lead to identification of a specific etiologic agent. Diagnosis of viral infections of the CNS has been revolutionized by the advent of new molecular diagnostic technologies to amplify viral nucleic acid from CSF, including PCR, nucleic acid sequence-based amplification, and branched-DNA assay. PCR is ideally suited for identifying fastidious organisms that may be difficult or impossible to culture and has been widely applied for detection of both DNA and RNA viruses in CSF. The technique can be performed rapidly and inexpensively and has become an integral component of diagnostic medical practice in the United States and other developed countries. In addition to its use for identification of etiologic agents of CNS disease in the clinical setting, PCR has also been used to quantitate viral load and monitor duration and adequacy of antiviral drug therapy. PCR has also been applied in the research setting to help discriminate active versus postinfectious immune-mediate disease, identify determinants of drug resistance, and investigate the etiology of neurologic disease of uncertain cause. This review discusses general principles of PCR and reverse transcription-PCR, including qualitative, quantitative, and multiplex techniques, with comment on issues of sensitivity, specificity, and positive and negative predictive values. The application of molecular diagnostic methods for diagnosis of specific infectious entities is reviewed in detail, including viruses for which PCR is of proven efficacy and is widely available, viruses for which PCR is less widely available or for which PCR has unproven sensitivity and specificity, and nonviral entities which can mimic viral CNS disease

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Section: Viruses For Which Pcr Has Potential Efficacy In Diagnosis Bumentioning

confidence: 99%

Molecular Methods for Diagnosis of Viral Encephalitis

2004

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“…In studies using nested PCR, it is suggested that VZV is an important etiological agent in acute aseptic meningitis (AAM) (11,17,18).…”

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confidence: 99%

Increased Detection Rate in Diagnosis of Herpes Simplex Virus Type 2 Meningitis by Real-Time PCR Using Cerebrospinal Fluid Samples

et al. 2007

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“…4 There is no history of tick exposure and no ticks were found on exam, so we can rule out tick paralysis. Myelopathy associated with herpes zoster virus is rare in the absence of a rash, 5 and with a normal MRI and no fever, back pain, meningeal signs, or risk factors, both pyogenic meningomyelitis and epidural abscess are unlikely. There is no history of trauma, crush injury, snake bite, or industrial exposure, so we can rule out several diagnoses under the trauma and toxic heading.…”

Section: Faculty Discussionmentioning

confidence: 99%

Clinicopathological Conference Weakness in the Kneesx

McLaughlin

Buchsbaum

2000

Academic Emergency Medicine

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The patient was a previously healthy 23-year-old white man who presented to the emergency department (ED) complaining of sudden onset of complete lower extremity paralysis. He had felt completely normal that morning when he awoke, but realized he couldn't move his legs when he fell to the floor while trying to get out of bed. He was able to drag himself along the floor and call a friend, who brought him to the ED. He felt well the day prior and had begun to lift weights at the gym. He denied any recent back pain or trauma. He complained of ''sore'' and ''crampy'' legs and mild subjective arm weakness. He denied any fever, chills, or loss of bowel or bladder function. He had felt ''jittery'' recently, but attributed it to school stress. He had no history of heavy metal exposure, recent upper respiratory infection, or known tick bites. He denied any visual complaints, palpitations, dyspnea, cough, diarrhea, rashes, headaches, hearing loss, weight loss, night sweats, or dysuria.The patient had never been hospitalized or had any episodes of weakness. He was not taking any medications and denied medication allergies. His parents were healthy, and he had no children or siblings. There was no family history of any neurologic disease. He admitted to binge drinking alcohol twice a month to significant intoxication and smoked one to two packs of cigarettes a day for ten years. He huffed gasoline once three months ago, but denied inhaling any other substances or any other illicit drug use. He worked as an air conditioning repairman.On examination, the patient's heart rate was 100 beats/min, blood pressure 164/60 mm Hg, re- spiratory rate 20 breaths/min, temperature 36.2ЊC, and SaO 2 98% on room air. He was alert and slightly nervous. He had mild facial acne and an otherwise normal head and neck exam. Cardiac exam showed a regular rate and rhythm with a soft 1/6 systolic murmur at the left upper sternal border. His lungs were clear and the abdominal exam was normal. The rectal exam was normal. His extremities were warm, with normal pulses and no edema. The skin was slightly flushed. On neurologic exam he was alert and oriented, cranial nerves were intact, and his sensory exam was normal throughout. He had 5/5 strength in the upper extremities and 2ϩ/5 strength in the lower extremities. The deep tendon reflexes (DTRs) were depressed in the lower extremities. A Babinski reflex was not present and cerebellar testing was normal.The patient was admitted to the ED's observation unit, and a repeat neurologic exam six hours later demonstrated improved motor strength. Upper extremities were 5/5 strength and lower extremities had improved to 4ϩ/5. He was then noted to have 3ϩ DTRs throughout and one beat of clonus in bilateral Achilles' reflex. Neurology consult was obtained and the patient was admitted to the hospital for further studies. Results of magnetic resonance imaging (MRI) of his brain and spinal cord were normal. His chest x-ray and electrocardiogram were normal. His complete blood count was normal and a chemistry panel fr...

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Infections of the Nervous System Caused by Varicella-Zoster Virus: A Review

Cited by 75 publications

References 78 publications

Molecular Methods for Diagnosis of Viral Encephalitis

Molecular Methods for Diagnosis of Viral Encephalitis

Increased Detection Rate in Diagnosis of Herpes Simplex Virus Type 2 Meningitis by Real-Time PCR Using Cerebrospinal Fluid Samples

Clinicopathological Conference Weakness in the Kneesx

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