Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment

Grahn, Anna; Studahl, Marie

doi:10.1016/j.jinf.2015.06.004

Cited by 140 publications

(139 citation statements)

References 131 publications

(183 reference statements)

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“…Outcome in both entities has been previously discussed to be similar (Raschilas et al 2002;Sonneville et al 2015) and is often characterized by neuropsychological deficits (Grahn and Studahl 2015) which is in accordance with our findings. In contrast with previously reported fatality rates of 7-35 % in HSVE and of 20 % in VZVE (Grahn and Studahl 2015;Granerod et al 2010;Sili et al 2014;Singh et al 2016), the outcome in our study was more favorable as none of our patients died.…”

Section: Patients With Confirmed Herpes Virus Encephalitis: Hsv Vzvsupporting

confidence: 92%

“…MRI typically demonstrates ischaemic changes involving cortical and deep gray-white matter and may include changes in the cerebellum and cervical medulla as well (Grahn and Studahl 2015). In our quantitatively limited study, MRI showed pathologic lesions on T2-weighted images in 2 patients.…”

Section: Mri Imagingmentioning

confidence: 56%

“…Furthermore, clinical presentation of VZVE is rather subacute and shows lower frequency of temporal EEG slowing or seizures in comparison to HSVE (Grahn and Studahl 2015). VZV CNS infection-related vasculopathy may lead to acute stroke accompanied by cerebellitis and retinal necrosis, abnormalities of cranial nerves and cervical myelon.…”

Section: Patients With Confirmed Herpes Virus Encephalitis: Hsv Vzvmentioning

confidence: 99%

“…The most frequent viral causes comprise enteroviruses, HSV (herpes simplex virus) 1, and varicella zoster virus (VZV) as well as adenovirus (Frantzidou et al 2008;George et al 2014;Grahn and Studahl 2015;Koskiniemi et al 2001;Long 2011;Vora et al 2014). In contrast, immunocompromised patients typically present with cytomegalovirus (CMV), Epstein-Barr virus (EBV), or human herpes virus (HHV) 6 or 7 infection of the brain.…”

Section: Introductionmentioning

confidence: 99%

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A study on viral CNS inflammation beyond herpes encephalitis

et al. 2016

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The early diagnosis of herpes simplex virus encephalitis (HSVE) enables induction of antiviral therapy in this potentially life-threatening disease. The study aimed to determine clinical findings including cerebrospinal fluid (CSF) data and MRI imaging in HSVE patients and to identify features distinguishing HSVE from encephalitis of other viral etiologies. We retrospectively reviewed consecutive patients who were diagnosed with viral encephalitis between 2000 and 2014 at the University Hospital Halle. Forty-nine patients with viral encephalitis were identified. A viral etiology could be confirmed by PCR or antibody testing in 22/49 (44.9 %) of patients (15 (30.6 %) HSV, 5 (10.2 %) VZV, 2 (4.1 %) EBV). In HSVE, typical findings were focal slowing in electroencephalophy (EEG) (80 %, p = 0.021) and presence of cortical (86.7 %, p = 0.030) lesions in MRI. Restricted diffusion was particularly helpful in detection of early signal abnormalities in HSVE (p = 0.014). In 27/49 (55.1 %) of patients, no causative agent could be elucidated. In these patients, 15/27 (55.6 %) experienced a rather "benign" disease course with no MRI pathology despite initially HSVE mimicking clinical picture. However, CSF was significantly different showing a higher amount of granulocytes and activated lymphocytes. The remaining 12/27 (44.4 %) patients developed MRI changes consistent with encephalitis, in 4 of these patients, disease course was fatal. Beside PCR-based serology as standard procedure, MRI including diffusion-weighted images and EEG represent additional tools in early HSVE diagnosis. CSF cytology might be particularly supportive in differentiating likely benign forms of encephalitis.

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Section: Patients With Confirmed Herpes Virus Encephalitis: Hsv Vzvsupporting

confidence: 92%

Section: Mri Imagingmentioning

confidence: 56%

Section: Patients With Confirmed Herpes Virus Encephalitis: Hsv Vzvmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A study on viral CNS inflammation beyond herpes encephalitis

et al. 2016

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“…JCV and HIV-1 are important examples of neurotropic viruses causing neurological infections to which the CRISPR/ Cas9 gene editing approach has been applied and thus they will be discussed first [11,12]. Potentially, the CRISPR/Cas9 could be applied to other DNA viral infections of the human CNS, including herpes simplex encephalitis, which can be caused by herpes simplex type 1 (HSV1) or type 2 (HSV2) [13,14]; cytomegalovirus (CMV) encephalitis, caused by CMV and seen in patients with AIDS [15,16]; adenovirus infection-associated CNS dysfunction in children [17]; and varicella zoster encephalitis caused by varicella zoster virus, which is the agent that causes chickenpox in children and shingles in adults [18]. These are also mentioned below.…”

Section: Viral Diseases Of the Cnsmentioning

confidence: 99%

Gene Editing for Treatment of Neurological Infections

et al. 2016

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The study of neurological infections by viruses defines the field of neurovirology, which has emerged in the last 30 years and was founded upon the discovery of a number of viruses capable of infecting the human nervous system. Studies have focused on the molecular and biological basis of viral neurological diseases with the aim of revealing new therapeutic options. The first studies of neurovirological infections can be traced back to the discovery that some viruses have an affinity for the nervous system with research into rabies by Louis Pasteur and others in the 1880s. Today, the immense public health impact of neurovirological infections is illustrated by diseases such as neuroAIDS, progressive multifocal leukoencephalopathy, and viral encephalitis. Recent research has seen the development of powerful new techniques for gene editing that promise revolutionary opportunities for the development of novel therapeutic options. In particular, clustered regulatory interspaced short palindromic repeat-associated 9 system provides an effective, highly specific and versatile tool for targeting DNA viruses that are beginning to allow the development of such new approaches. In this short review, we discuss these recent developments, how they pertain to neurological infections, and future prospects.

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Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid

et al. 2022

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Background VZV infection can involve every level of the neurologic system: from the central nervous system (CNS) to the peripheral nervous system (PNS), including aseptic meningitis. Prognosis seems to differ between these neurological involvements. Prognostic factors remain unknown. Methods This is a retrospective multicenter study including all patients with a positive VZV polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) from eight centers in Paris (France) between 2011 and 2018. Unfavorable outcome was defined as mortality linked to VZV or incomplete recovery. Modified Rankin Scale (mRS) evaluated disability before and after the infection, with the difference designated as Rankin Delta. Results Seventy‐two patients were included (53% male, median age 51 years, median mRS 0). Immunosuppression was reported in 42%. The clinical spectrum included 26 cases of meningitis, 27 instances of CNS involvement, 16 of PNS involvement, and 3 isolated replications (positive PCR but no criteria for neurological complications from VZV). Antiviral treatment was administered to 69 patients (96%). Sixty‐two patients completed follow‐up. Death linked to VZV occurred in eight cases. Unfavorable outcome (UO) occurred in 60% and was significantly associated with a higher prior mRS (Odd‐ratio (OR) 3.1 [1.4–8.8] p = .012) and the presence of PNS or CNS manifestations (OR 22 [4–181] p = .001, OR 6.2 [1.3–33] p = .03, respectively, compared to meningitis). In the CSF, higher protein level (p < .0001) was also significantly associated with a higher Rankin Delta. Conclusions Neurological complications of VZV with evidence of CSF viral replication are heterogeneous: aseptic meningitis has a good prognosis, whereas presence of CNS and PNS involvement is associated with a higher risk of mortality and of sequelae, respectively.

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Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment

Cited by 140 publications

References 131 publications

A study on viral CNS inflammation beyond herpes encephalitis

A study on viral CNS inflammation beyond herpes encephalitis

Gene Editing for Treatment of Neurological Infections

Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid

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