Meningoencephalitis Due to Varicella Zoster Virus in Aids Patients. Report of Eleven Cases and Review of the Literature

Abstract

Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.

Determinants of neurological syndromes caused by varicella zoster virus (VZV)

“…Investigation of CSF samples from HIV positive individuals revealed anti-VZV intrathecal antibody synthesis in 16%, suggesting a significant disease burden of subclinical VZV CNS infection in this patient population (Birlea et al 2011 ). Reactivation of VZV in the CNS in AIDS patients is generally associated with a severe diffuse meningoencephalitis, and in some cases, vasculitis, granulomatous angiitis or myelitis (Gilden et al 2009 ; Corti et al 2015 ; Kennedy 1988 ). Although myelitis is an extremely rare complication of VZV infection, it is relatively more prevalent in immunocompromised individuals, including AIDS patients, who are prone to atypical presentations and poorer outcomes (Manian et al 1995 ).…”

Mass-spectrometric profiling of cerebrospinal fluid reveals metabolite biomarkers for CNS involvement in varicella zoster virus reactivation

“…Antibodies are not detected up to two weeks after acute infection and can persist in humans after initial infection [ 9 ]. In terms of pathogen-independent CSF parameters, pleocytosis is usually present in VZV reactivation affecting the CNS [ 10 ] but can be absent especially in immunocompromised patients [ 11 ] or complications such as VZV vasculopathy [ 12 ]. With respect to experimental markers, increased CSF concentrations of neurofilament protein and glial fibrillary acidic protein were recently described in VZV-infected patients with facial palsy, indicating neuronal damage and astrogliosis, but their levels did not correlate with outcome [ 13 , 14 ].…”

Varicella-zoster virus (VZV) multifocal vasculopathy in a patient with systemic lupus erythematosus — a diagnostic and treatment dilemma

“…Persistently low CSF glucose in the setting of broad systemic antimicrobial therapy was also puzzling. While CSF protein has been reported by Corti et al [10] to be elevated in VZV meningoencephalitis in the setting of AIDS (median of 2100 mg/dL), whether such high values apply to all patients with diminished immunity is unclear. Moreover, both the angiogram and first two CSF samples tested for VZV PCR were negative.…”