The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy

Abstract

In varicella zoster virus (VZV) vasculopathy, the diagnostic value of detecting anti-VZV IgG antibody in CSF is greater than that of detecting VZV DNA. Although a positive PCR for VZV DNA in CSF is helpful, a negative PCR does not exclude the diagnosis of VZV vasculopathy. Only when the CSF is negative for both VZV DNA and anti-VZV IgG antibody can the diagnosis of VZV vasculopathy be excluded.

Issues in the Treatment of Neurological Conditions Caused by Reactivation of Varicella Zoster Virus (VZV)

“…It should be appreciated, however, that several of these complications are based on individual case reports, and zoster is not a frequent cause of these complications. The clinical diagnosis may be difficult, especially when not temporally associated with the typical zosteriform rash, but the condition is usually characterized by magnetic resonance imaging and computed tomography features of cerebral ischemia or hemorrhage, which may affect both gray and white matter, evidence of narrowing and/or beading of cerebral arteries seen on angiography, and a pleocytosis with mononuclear cells detected in the cerebrospinal fluid (CSF) [25]. Typically, a patient with VZV vasculopathy may present with progressive cognitive decline and confusion, seizures, and focal neurological deficits [1], but the clinical presentation is protean [24].…”

“…Infected arteries contain Cowdry A inclusion bodies, multinucleated giant cells, herpes virions, and both VZV DNA and antigen [26]. Both PCR to detect VZV DNA in the CSF and detection of anti-VZV IgG antibody in the CSF have been used successfully to diagnose VZV vasculopathy, but studies have shown, perhaps somewhat surprisingly, that this latter serological method is a more sensitive diagnostic marker of this condition than PCR analysis [25]. It is important to measure the ratio of anti-VZV antibody/total IgG in the CSF and blood, and not just the total anti-VZV antibody.…”

“…A diagnosis of ZSH should always be considered in the relevant clinical context, particularly where there is a history of persistent radicular pain. It is now clear that VZV reactivation without rash can cause many, if not all, of the various neurological disorders known to be associated with herpes zoster, including VZV vasculopathy, where > 40 % of cases may occur without any antecedent rash [25,29]. ZSH should at least be considered in an individual who presents with acute, subacute, or chronic brain or spinal cord disease of unknown cause, especially if accompanied by a CSF pleocytosis.…”

Neuro-Intensive Care of Patients with Acute CNS Infections

“…PCR detection of VZV DNA has a specificity of >95%, but the sensitivity is ≤30% in some studies [69]. In cases of VZV CNS vasculopathy, CSF should also be tested for intrathecal synthesis of VZV specific antibody (IgM and IgG CSF/serum ratio), as these studies are complementary to PCR and may be positive when PCR tests are negative [69].…”

“…In cases of VZV CNS vasculopathy, CSF should also be tested for intrathecal synthesis of VZV specific antibody (IgM and IgG CSF/serum ratio), as these studies are complementary to PCR and may be positive when PCR tests are negative [69]. In a recent study, CSF VZV specific IgG was detected in 100% (14/14) of cases, but PCR was positive in only 28% [69].…”