scholarly journals Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Thomas Pasedag ◽  
Karin Weissenborn ◽  
Ulrich Wurster ◽  
Tina Ganzenmueller ◽  
Martin Stangel ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Cell Count ◽  
Varicella Zoster Virus ◽  
Total Protein ◽  
Antiviral Treatment ◽  
Neurological Deficits ◽  
Healthy Population ◽  
Varicella Zoster ◽  
Csf Analysis ◽  
Acute Headache

Meningitis caused by varicella zoster virus (VZV) is rare in healthy population. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. Here we report a young otherwise healthy man diagnosed with a VZV meningitis without rash. He complained of acute headache, nausea, and vomiting. The clinical examination did not show any neurological deficits or rash. Cerebrospinal fluid (CSF) analysis revealed a high leukocyte cell count of 1720 cells/µL and an elevated total protein of 1460 mg/L misleadingly indicating a bacterial infection. Further CSF analyses, including polymerase chain reaction (PCR) and detection of intrathecal synthesis of antibodies, showed a VZV infection. Clinical and CSF follow-up examinations proved the successful antiviral treatment. In conclusion, even young immunocompetent patients without rash might present with VZV meningitis. CSF examination is a key procedure in the diagnosis of CNS infections but in rare cases the standard values cell count and total protein might misleadingly indicate a bacterial infection. Thus, virological analyses should be considered even when a bacterial infection is suspected.

Distinguishing neurosarcoidosis from multiple sclerosis based on CSF analysis

Neurology ◽  
2020 ◽  
Vol 94 (24) ◽  
pp. e2545-e2554
Author(s):  
Tarunya Arun ◽  
Laura Pattison ◽  
Jacqueline Palace
Keyword(s):  
Multiple Sclerosis ◽  
Cell Count ◽  
Total Protein ◽  
White Cell Count ◽  
Binary Logistic Regression ◽  
White Cell ◽  
Oligoclonal Bands ◽  
Csf Analysis ◽  
Elevated Protein ◽  
Oligoclonal Igg

ObjectiveTo characterize a cohort of patients with neurosarcoidosis with particular focus on CSF analysis and to investigate whether CSF values could help in distinguishing it from multiple sclerosis (MS).MethodsThis retrospective cohort study enrolled 85 patients with a diagnosis of neurosarcoidosis (possible, probable, or definite). CSF total protein, white cell count, and angiotensin-converting enzyme levels were measured. CSF and serum oligoclonal immunoglobulin G (IgG) patterns were analyzed with the use of odds ratios and binary logistic regression.ResultsEighty patients had a probable (nonneural positive histology) or definite (neural positive histology) diagnosis of neurosarcoidosis. Most frequent findings on MRI were leptomeningeal enhancement (35%) and white matter and spinal cord involvement (30% and 23%). PET scan showed avid areas in 74% of cases. CSF analysis frequently showed lymphocytosis (63%) and elevated protein (62%), but CSF-selective oligoclonal bands were rare (3%). Serum ACE levels were elevated in 51% of patients but in only 14% of those with isolated neurosarcoidosis. Elevated CSF ACE was not found in any patient.ConclusionsLarge elevations in total protein, white cell count, and serum ACE occur in neurosarcoidosis but are rare in MS. The diagnostic use of these tests is, however, limited because minimal changes may occur in both. MS clinical mimics in neurosarcoidosis are not common, and intrathecal synthesis of oligoclonal IgG is a powerful discriminator because it is rare in neurosarcoidosis but occurs in 95% to 98% cases of MS. We suggest caution in making a diagnosis of neurosarcoidosis when intrathecal oligoclonal IgG synthesis is found.

scholarly journals Lesson of the Week: Potentially lethal bacterial infection associated with varicella zoster virus

BMJ ◽  
1996 ◽  
Vol 313 (7052) ◽  
pp. 283-285 ◽  
Author(s):  
A. J Pollard ◽  
A. Isaacs ◽  
E G H. Lyall ◽  
N. Curtis ◽  
K. Lee ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Varicella Zoster Virus ◽  
Varicella Zoster

scholarly journals Varicella-zoster virus aseptic meningitis: an atypical presentation in an immunocompetent male patient

2021 ◽  
Vol 2021 (6) ◽  
Author(s):  
Christina Platanaki ◽  
Leonidia Leonidou ◽  
Dimitrios Siagkris ◽  
Ιoanna Giannopoulou ◽  
Fotini Paliogianni ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
Aseptic Meningitis ◽  
Early Recognition ◽  
Rare Complication ◽  
Common Disease ◽  
Cns Involvement ◽  
Varicella Zoster ◽  
Csf Analysis ◽  
Polymerase Chain ◽  
Persistent Headache

ABSTRACT Varicella-zoster virus (VZV) reactivation causes a relatively common disease in immunocompromised patients characterized by rash and radiating pain. Aseptic meningitis is a rare complication of VZV infection and commonly is associated with exanthem and neurological signs. We present an atypical case of VZV meningitis in a healthy 56-year-old male who was initially presented with persistent headache as the only symptom. Anti-VZV immunoglobulin G titer both in serum and in cerebrospinal fluid (CSF) and the polymerase chain reaction (PCR) CSF analysis revealed VZV infection. Our case highlights the importance of considering VZV aseptic meningitis in immunocompetent individuals even in the absence of the typical presentation of meningitis. Screening techniques such as CSF, PCR as well as anti-VZV antibodies in CSF show that VZV meningitis is a common cause of aseptic meningitis and allows the early recognition of CNS involvement in the VZV infection.

scholarly journals Varicella Zoster Virus Infections in Canadian Children in the Prevaccine Era: A Hospital-Based Study

1997 ◽  
Vol 8 (6) ◽  
pp. 323-328 ◽  
Author(s):  
Susan Kuhn ◽  
H Dele Davies ◽  
Taj Jadavji
Keyword(s):  
Varicella Zoster Virus ◽  
Antiviral Treatment ◽  
Case Series ◽  
Neurological Complications ◽  
Immunocompetent Patient ◽  
Pulmonary Complications ◽  
Common Reason ◽  
Pediatric Hospital ◽  
Retrospective Case ◽  
Varicella Zoster

OBJECTIVE: To describe the clinical course of children admitted for varicella zoster virus (VZV) infections to a pediatric hospital before the release of VZV vaccine in Canada.DESIGN: Retrospective case series.SETTING: Tertiary pediatric hospital. Population studied was children aged 18 years or younger admitted to hospital between 1983 and 1992 who were discharged with a diagnosis of varicella or zoster. Of the 201 children who were identified, 36 were excluded, leaving 165 for analysis.RESULTS: There was a male:female ratio of 1.5:1 and a median age of 5.3 years (range two weeks to 18 years). The group included those who were previously healthy (70, 42.4%), immunocompromised (60, 36.4%), and those with nonimmunocompromising conditions (35, 21.2%). Comparison of immunocompetent and immunocompromised children revealed that complication of VZV infection was a more common reason for admission among the former (86 of 105, 81.9%, P<0.001), whereas treatment with acyclovir to limit dissemination was the most common reason in the latter (53 of 60, 88.3%, P<0.001). Skin and soft tissue infections were the most common complications in immunocompetent children (36 of 98) and those younger than five years (26 of 53), whereas pulmonary complications predominated among immunocompromised patients (eight of 98) and neurological complications in five- to 10-year-olds (16 of 36). Only one death (0.6%) occurred in an immunocompetent patient. Group A beta-hemolytic streptococci andStaphylococcus aureuscaused equal numbers of secondary infections (92% of all isolates).CONCLUSIONS: Complications of VZV infections and secondary prophylactic antiviral treatment of immunocompromised children explain the majority of hospitalizations in this institution, and can be monitored after VZV vaccine introduction. Complications vary significantly with underlying healthy status and age.

scholarly journals Acute cerebellar ataxia associated with varicella zoster virus encephalitis

2021 ◽  
Author(s):  
Madson Caio dos Santos Dantas ◽  
João Pedro Cardoso Prudêncio
Keyword(s):  
Varicella Zoster Virus ◽  
Cerebellar Ataxia ◽  
Rare Complication ◽  
Skin Lesions ◽  
Pupillary Response ◽  
University Hospital ◽  
Varicella Zoster ◽  
Csf Analysis ◽  
Acute Cerebellar Ataxia ◽  
Vesicular Rash

Context: Varicella-zoster virus (VZV) primary infection causes a diffuse vesicular rash and affects mainly young people. VZV-associated encephalitis is a rare complication since the advent of vaccination, and can present as different neurological syndromes. This report aims to describe a case of acute cerebellar ataxia after VZV-associated encephalitis in a child, admitted to the Onofre Lopes University Hospital (HUOL) in Natal, Brazil. Case report: We present the case of a 9-year-old girl referred to HUOL with polymorphic skin lesions for 8 days. She evolved with headache, vomiting, drowsiness and confusion. Upon admission, she was pale (+/4+), anicteric, confused (GCS=14), hemodynamically stable, SaO2=99%, with pupillary response and no meningism. Laboratory tests showed Hb 11.7g/dl, leukocytes 7,200/mm³ (93% segmented, 1% eosinophils, 5% lymphocytes and 2% monocytes), AST 38U/ml and ALT 46U/ml. Once clinical diagnosis of VZVencephalitis was made, the patient was admitted to the ICU for monitoring and treatment. Cranial CT showed hypodensities on the frontal and occipital lobes; CSF analysis: glucose=76mg/dl, proteins=24mg/dl, leukocytes=9/mm3 (monocytes 78%). She improved progressively and was transferred to the ward, evolving with ataxia, suggesting cerebellitis. Conclusions: This case describes a chickenpox rare complication nowadays: encephalitis. Along evolution, the patient presented acute cerebellar ataxia, a more prevalent condition in children, usually having a limited course.

scholarly journals An Association of Varicella Zoster Virus, Facial Palsy, and Meningitis in a Young Immunocompetent Male

2020 ◽  
Vol 12 (1) ◽  
pp. 136-139
Author(s):  
Amr Ashour ◽  
Khaldun Obeidat ◽  
Bahjat Azrieh ◽  
Arwa Alsaud ◽  
Mohamed Yassin
Keyword(s):  
Varicella Zoster Virus ◽  
Facial Nerve Palsy ◽  
Secondary Infection ◽  
Neurological Deficits ◽  
Trigeminal Ganglia ◽  
Male Adult ◽  
Varicella Zoster ◽  
Meningeal Involvement ◽  
Rare Manifestation ◽  
Polymerase Chain

Varicella zoster is a secondary infection caused by the virus of chickenpox, after becoming latent in neurons of dorsal root ganglia or trigeminal ganglia. Varicella zoster virus (VZV) can be reactivated years later to produce shingles (zoster), generally in immunocompromised adults to produce neurological deficits and rash. Meningeal involvement of VZV is also reported and can be diagnosed. Herein, we report a 39-year-old immunocompetent male adult with a rare manifestation caused by VZV. The report is an association between facial nerve palsy and a polymerase chain reaction-confirmed VZV meningitis, even without the dermal typical rash. The patient eventually recovered after receiving acyclovir intravenously.

scholarly journals 866. Increased Diagnosis of Varicella-Zoster Virus Infection of the Central Nervous System With the BioFire FilmArray Meningitis/Encephalitis Panel

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S22-S23
Author(s):  
Lynette Chen ◽  
Matthew Pettengill ◽  
Bryan Hess ◽  
Joseph DeSimone
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Varicella Zoster Virus ◽  
Antiviral Therapy ◽  
Cns Infection ◽  
Varicella Zoster Virus Infection ◽  
Cns Disease ◽  
Varicella Zoster ◽  
Csf Analysis ◽  
The Central Nervous System

Abstract Background Varicella-zoster virus (VZV) infection of the central nervous system (CNS) is relatively uncommon. Diagnostic tests historically utilized culture, serologies, and targeted PCR methods. In April 2016, our institution began using the BioFire FilmArray meningitis/encephalitis (BFME) panel for cerebrospinal fluid (CSF) specimen analysis. We hypothesized that the diagnosis of VZV CNS infection increased at our institution with the implementation of this diagnostic panel. Methods We conducted chart reviews of patients from 2 time periods. In the first period, April 2013–March 2016, BFME was not available for CSF analysis (pre-BFME period). We reviewed all positive CSF VZV PCR results during this period. Medical charts of these patients were reviewed for epidemiology, clinical presentation, treatment course, and outcome. In the second period, April 2016–March 2018, BFME was performed on all CSF specimens obtained by lumbar puncture (BFME period). Patients with a positive VZV result on BFME underwent similar chart review. Results In the 3-year pre-BFME period, 292 VZV PCR tests were performed. Six patients were diagnosed with VZV CNS infection; median age 61 years. Five of the 6 patients (83%) had cutaneous zoster. All 6 patients received antiviral therapy. Five of the 6 patients clinically improved; 1 patient with VZV encephalitis died. In the 2-year BFME period, 1,113 CSF samples were evaluated, and 18 of these were positive for VZV (1.6%); median age 55 years. Only 7 of the 18 (39%) had cutaneous zoster at the time of hospitalization. All 18 received antiviral therapy with clinical improvement. Conclusion Prior to implementation of the BFME panel at our institution, VZV CNS infection was rarely diagnosed. Diagnosis at that time relied on physicians’ requests for a targeted CSF VZV PCR. The majority of the patients during that period had a concurrent zoster rash. In a shorter period utilizing syndromic testing (BFME) on CSF specimens, we diagnosed 3 times as many cases of VZV CNS disease. Only a minority of these patients presented with a concurrent zoster rash. The use of syndromic testing of CSF will likely identify more cases of VZV CNS disease. Disclosures All authors: No reported disclosures.

scholarly journals Cerebrospinal fluid findings and hypernatremia in COVID-19 patients with altered mental status

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Hale Toklu ◽  
Latha Ganti ◽  
Ettore Crimi ◽  
Cristobal Cintron ◽  
Joshua Hagan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Count ◽  
Mental Status ◽  
Total Protein ◽  
Neuron Specific Enolase ◽  
Altered Mental Status ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Csf Analysis ◽  
Normal White Blood Cell

Abstract Background The objective of the study was to assess the cerebrospinal fluid (CSF) findings in COVID-19 patients. Aims This was an observational retrospective cohort from electronic medical records of hospitalized patients (n = 2655) with confirmed COVID-19 between February 15, 2020, and April 15, 2020, in 182 hospitals from a large health system in the USA. The review of data yielded to a total of 79 patients in 20 hospitals who had CSF analysis. Methods Outcomes during hospitalization, including hospital length of stay, disease severity, ventilator time, and in-hospital death were recorded. Independent variables collected included patient demographics, diagnoses, laboratory values, and procedures. Results A total of 79 patients underwent CSF analysis. Of these, antigen testing was performed in 73 patients. Ten patients had CSF analysis for general markers such as total protein, cell count, glucose, clarity, and color. Seven of the 10 cases (70%) had normal total cell count and normal white blood cell count in CSF. Sixty-three percent (5/8) had elevated total protein. Two patients had normal levels of lactate dehydrogenase (LDH) and 1 patient had significantly elevated (fourfold) neuron-specific enolase (NSE) level in CSF. Conclusion Unlike bacterial infections, viral infections are less likely to cause remarkable changes in CSF glucose, cell count, or protein. Our observations showed no pleocytosis, but mild increase in protein in the CSF of the COVID-19 patients. The fourfold elevation of NSE may have diagnostic/prognostic value as a biomarker in CSF for COVID-19 patients who have altered mental status. Graphical abstract

scholarly journals The Seroprevalence of Varicella Zoster Virus in a Healthy Population from Tehran, Iran

2018 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Alireza Fahimzad ◽  
Mahdi Nouri ◽  
Farideh Shiva ◽  
Ahmad Reza Shamshiri ◽  
Zari Gholinejad ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
Healthy Population ◽  
Varicella Zoster
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