Polymerase Chain Reaction Detection and Clinical Significance of Varicella‐Zoster Virus in Cerebrospinal Fluid from Human Immunodeficiency Virus‐Infected Patients

Burke, Don; Kalayjian, Robert C.; Vann, Vincent R.; Madreperla, Steven A.; Shick, H. Elizabeth; Leonard, Debra G.B.

doi:10.1086/516516

Cited by 47 publications

(18 citation statements)

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“…The patient we describe is a rare case of severe VZV encephalitis presenting significant deviation from the expected clinical and laboratory presentation: (1) Brain involvement by VZV usually occurs in immunosuppressed, mainly those with acquired immune deficiency syndrome, 20 and is uncommon in immunocompetent patients. 4,8,21,22 (2) Encephalitis from VZV is now recognized to be a vasculopathy affecting large or small vessels.…”

Section: Discussionmentioning

confidence: 95%

“…34 CSF PCR analysis for VZV DNA has been critical in identifying VZV as a causative factor in cases of CNS infections that may be clinically confusing as cases without skin manifestations. 11,20,24,34,35 In viral encephalitis, intrathecal IgG antibodies are measured in the post-acute stage from day 7 to day 12 of the disease, reach maximum values on day 20, and then persist for several years. 17 Intrathecal immune response may be further delayed or even absent when antiviral treatment is started early.…”

Section: Varicella-zoster Encephalitis Mpaka Et Almentioning

confidence: 99%

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Atypical presentation of varicella-zoster virus encephalitis in an immunocompetent adult

2008

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Section: Discussionmentioning

confidence: 95%

Section: Varicella-zoster Encephalitis Mpaka Et Almentioning

confidence: 99%

Atypical presentation of varicella-zoster virus encephalitis in an immunocompetent adult

2008

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“…The diagnostic yield of CSF PCR among patients with VZV vasculopathy has been reported to be 28%, with the decreased sensitivity attributed to the significant delay (average 4.2 months) between the onset of neurologic symptoms and molecular testing in these cases (90). VZV DNA can be amplified from the CSF in 2.5% to 7% of HIV-infected patients with new neurologic signs or symptoms (94,95). The significance of this finding is not always clear, as VZV may accompany other CNS pathogens, suggesting subclinical reactivation in some cases (95).…”

Section: Laboratory Evaluation Pcr Detectionmentioning

confidence: 99%

Infections of the Central Nervous System

Reznicek¹,

Bloch²,

Tang³

2010

Infectious Disease and Therapy

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INTRODUCTIONViral infections of the central nervous system (CNS) often present a diagnostic dilemma. The number of causative agents is vast, much greater than a century ago, when the established etiologies of CNS infections were mainly limited to rabies virus and polio virus. The physical findings of CNS infection are often nonspecific, and initial laboratory results may provide few additional clues as to the etiology. Molecular diagnostic testing has dramatically improved the ability to detect viral CNS infections, but requires expertise in the attributes and limitations of these techniques. Even discriminating infectious from noninfectious causes may be challenging, as metabolic, autoimmune, neoplastic, toxic, and endocrinologic entities may mimic meningitis or encephalitis. CNS infections represent syndromes where close collaboration between clinicians and laboratorians is crucial in providing a rapid diagnostic evaluation and an appropriate interpretation of results.This chapter concentrates on viral infections of the CNS in immunocompetent adults, with a focus on assessment and laboratory evaluation. The close anatomical proximity of meninges and brain parenchyma often blurs the distinction between meningitis and encephalitis, causing an overlap syndrome termed meningoencephalitis. For the purposes of this chapter, meningoencephalitis will be considered a subset of encephalitis, while meningitis will refer to isolated inflammation of the meninges. There is significant geographic variability with respect to the microbiology of CNS infections, and the following discussion will highlight the most significant viral pathogens in the United States. A brief overview of laboratory diagnostic techniques will initially be provided followed by a more detailed discussion specifically relating to the various viral pathogens.

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“…Cutaneous VZV IRD has been reported in 8-12% of adults [9, 50,51] and in up to 11% of children [52]. In the pre-HAART era the prevalence of clinical CNS VZV disease was 0.7-7% [53,54]. There are a few reports of CNS VZV IRD, including one patient with transverse myelitis [55] and two patients with encephalitic presentations [56,57].…”

Section: Varicella Zoster Virusmentioning

confidence: 99%