Varicella zoster virus infection of the central nervous system – 10 year experience from a tertiary hospital in South India

Abstract

Introduction:Varicella zoster virus is an exclusively human neurotrophic virus. The primary infection with the virus causes varicella. The virus remains latent in nervous tissue and upon secondary activation causes a variety of syndromes involving the central nervous system (CNS) including meningoencephalitis and cerebellitis.Materials and Methods:In this study, we looked at the epidemiology, clinical and laboratory features, and outcomes of patients who were admitted with varicella zoster of the CNS from 2005 to 2014.Results:There were 17 patients. Fever was present in 13 patients, seizures in 9 patients and headache and vomiting in 4 patients each. A generalized varicella rash was present in 8 out of 17 patients. A single dermatomal herpes zoster was present in seven patients. Two patients had no rash. Varicella zoster polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) was done in 5 patients of which 4 were positive and 1 was negative. Nine patients had diabetes with an average glycated hemoglobin of 8.6%. Total number of deaths was five.Conclusions:Patients with diabetes who develop varicella or herpes zoster may be at risk for CNS complications. The diagnosis of varicella encephalitis has to rest on a combination of clinical findings and CSF PCR, as neither the rash nor the PCR is sensitive enough to diagnose all the cases with varicella encephalitis.

Orofacial Dyskinesia and Intractable Hiccups in a Patient with Varicella-zoster Virus Encephalomyelitis

“…The total prevalence of these neurological diseases among immunocompetent people is 0.1-0.3% but reaches up to 35% among immunocompromised individuals ( 2 , 3 ). Immunocompromised patients with herpes zoster, including those with diabetes mellitus (DM), have an increased risk for central nervous system (CNS) disease ( 4 ).…”

Retroviral Disease in Immunocompromised Patient Causing Varicella Encephalitis and TB meningitis –A Case Report

“…The virus then enters the dormant stage in the ganglia of cranial nerves, dorsal route and in autonomic nervous system. 2 In adulthood reactivation of the virus is observed with aging or when there is decline T-cell-mediated immunity affecting central or peripheral nervous system causing number of complications of neurological syndromes like encephalitis, herpes zoster, vasculopathy, myelopathy and cerebellitis. 3,4 Inpatient above age of 80 the incidence varies from 2-4.6 from 1000 person-years to 10 per person-years.…”