Fig 1 vesicular rash caused by herpes zoster varicella zoster commonly known as. Varicella zoster virus vzv encephalitis can be due to either an immune reaction to primary infection or reactivation of latent infection in cranial nerve or dorsal root ganglia following childhood chickenpox. Varicella zoster meningoencephalitis following treatment. Delays in starting treatment, particularly beyond 48 hours after hospital admission, are associated with a worse prognosis. Varicella zoster virus vzv is a virus of the alphaherpesvirinae subfamily, responsible for human infections with various clinical presentations. Manifestations following primary infection include. The incubation period is about 14 days range 9 to 21 days. Cerebrospinal fluid analysis confirmed the diagnosis of vzv associated encephalitis and the patient was treated with intravenous acyclovir and steroids with full recovery back to preadmission neurological status. Similarly to varicella, there is a vaccine available to protect against herpeszoster infections. Acute disseminated encephalomyelitis is a noninfective inflammatory encephalitis that may require to be treated with steroids. We aimed to investigate characteristics of hospitalized children with varicella in brazil in the prevaccine period and to identify predictors for requiring intensive care treatment. Primary infection occurs most frequently during childhood and presents as varicella. Although no clinical trial has established the efficacy of antiviral therapy for varicella zoster virusassociated encephalitis, on the basis of case reports and small series, acyclovir 1015 mgkg intravenously every 8 h for 1014 days is the drug of choice.
Even when clinical symptoms of chickenpox have resolved, vzv remains dormant in the nervous. After the primary infection, vzv stays in the body in the sensory nerve ganglia as a latent infection. One of the potential complications of this infection is involvement of the. This study investigated characteristics of clinical and laboratory features in patients with vzv infection. The diagnosis is made by serology and pcr in cerebrospinal fluid, while acyclovir is the cornerstone of treatment. Characteristic signs of zosterassociated encephalitis include acute delirium, typical signs of stroke such as headache with acute hemiplegia, aphasia, ataxia, hemisensory loss, or. Varicella zoster virus in the adult patient most commonly presents as shingles. Chickenpox for healthcare professionals varicella cdc. Acute varicellazoster complications bmj best practice. Pickering lk, baker cj, kimberlin dw, long ss, eds. Varicella zoster virus infections in neurological patients. Pdf varicellazoster virus encephalitis in an aids patient. The same virus also causes herpes zoster shingles in adults. The causative agent for shingles is the varicella zoster virus vzv a doublestranded dna virus related to the herpes simplex virus.
Brain stem encephalitis due to varicellazoster virus in a patient with aids article pdf available in clinical infectious diseases 205. Both varicella and herpes zoster that are caused by varicellazoster virus vzv. Varicella zoster virus vzv reactivation is a common infectious disease in neurology and vzv the second most frequent virus detected in encephalitis. Most individuals are infected with this virus as children which causes an episode of chickenpox. Two hundred eighty two patients with vzv reactivation that were hospitalized in the department of. Latent varicellazoster virus is located predominantly in neurons in human trigeminal ganglia. Varicella zoster virus encephalitis radiology reference.
Following im administration of vzig, bioavailability expected to be almost 100%. Varicellazoster virus vzv is an exclusively human virus. Herpes zoster encephalitis an overview sciencedirect. Purpose the federal bureau of prisons bop clinical guidance for the management of varicella zoster virus vzv infections provides recommendations for the medical management of federal inmates with varicella chickenpox and herpes zoster shingles, as well as for prevention and. In most cases, the presence of focal neurological signs and focal seizures will distinguish encephalitis from encephalopathy. Two days after his pediatrician had diagnosed herpes zoster and prescribed oral acyclovir 400.
Primary varicella infection chickenpox was not reliably distinguished from smallpox until the end of the 19th century. Encephalitis, imaging, varicella zoster virus, vasculopathy. Primary varicella zoster virus infection results in chickenpox varicella, which may result in complications including encephalitis, pneumonia either direct viral pneumonia or secondary bacterial pneumonia, or bronchitis either viral bronchitis or secondary bacterial bronchitis. Characteristic signs of zoster associated encephalitis include acute delirium, typical signs of stroke such as headache with acute hemiplegia, aphasia, ataxia, hemisensory loss, or. In immunocompromised children, progressive, severe varicella may occur with continuing eruption of lesions sometimes including hemorrhagic skin lesions along with high fever persisting into the second week of illness and visceral dissemination ie, encephalitis, hepatitis, and pneumonia.
The development of neurological complications due to varicella zoster virus vzv reactivation is relatively uncommon, particularly in the case of immunocompetent patients. Varicellazoster virus infections of the central nervous system. Like other herpes viruses, vzv has the capacity to persist in the body after the primary first infection as a latent infection. More than 95% of adults aged 20 years born in the united states have immunity to varicellazoster virus vzv, mostly due to primary vzv infection, known as varicella or chickenpox.
Zoster associated encephalitis from disseminated vzv can develop within days of the disseminated rash, and should be strongly suspected in immunosuppressed patients. Acute varicella zoster encephalitis without evidence of primary. Although the invitro data are impressive, limited information is available on its efficacy in the treatment of varicella zoster encephalitis 3. Antinmdar encephalitis with concomitant varicella zoster. Disseminated varicella zoster virus encephalitis the lancet. The prognosis of herpes simplex virus encephalitis has been dramatically improved by the use of acyclovir and this treatment is recommended in the guidelines. Varicellazoster virus encephalitis in an aids patient article pdf available in brazilian journal of infectious diseases 83. However, varicella can cause severe complications such as soft tissue infection, pneumonia, hepatitis, reye syndrome, and encephalitis. Patients at increased risk of complications include adolescents, adults, pregnant women, and immunocompromised hosts. A case of meningitis due to varicella zoster virus. Perinatal varicella american academy of pediatrics. Management of herpes simplex and varicellazoster infections. Intravenous acyclovir has been shown to be effective in the treatment of initial and recurrent herpes simplex virus infections in immunocompetent and immunocompromised persons 1, 2.
Varicella zoster virus encephalitis has been described during the course of or after varicella or zoster with various time frames. Firstline treatment for vzv encephalitis is acyclovir 1015 mgkg, tid, 1014 days. It is caused by varicellazoster virus vzv, which is a dna virus that is a member of the herpesvirus group. Furthermore, the most favourable treatment regimen has not been determined. Acute encephalitis in immunocompetent adults the lancet. Acute varicella zoster encephalitis without evidence of. Herpes zoster infections are frequently observed after allogeneic bone marrow transplantation allobmt. This case report demonstrates a rare presentation of antinmdar encephalitis with concomitant vzv detection in the setting of a nonteratomatous gynecologic tumor. Early recognition of secondary bacterial infection and appropriate followup are major issues. Childrens national medical center, washington, dc 1. This infection is common, affecting almost all nonvaccinated. Study of complications of varicellazoster virus infection. Varicellazoster virus encephalitis is a serious complication with an incidence of 1 to 2 per 10,000 cases of varicella in healthy persons and is seen more frequently in infants and adults. Guidelines for the diagnosis and treatment of patients with encephalitis were.
Varicella zoster virus centers for disease control and. Vzv encephalitis is a disease of the young and elderly immunocompetent patients, as well as a disease of the immunocompromised of all ages, as illustrated by four young adults enrolled in our study. Treatment of acyclovir and dexamethasone for 2 weeks led to complete resolution of meningitis and urinary retention. Federal bureau of prisons management of vzv infections clinical guidance december 2016 1 1. After 7 to 53 days of antiviral treatment, another 5 patients 2 with encephalitis and 3 with meningitis developed diplopia due to oculomotor. Characterization of virusspecific immune response during. Varicellazoster virus encephalitis and vasculopathy in a. Varicella zoster virus encephalitis is a serious complication with an incidence of 1 to 2 per 10,000 cases of varicella in healthy persons and is seen more frequently in infants and adults. In the 1980s the outcome of patients with herpes simplex virus hsv encephalitis was shown to be dramatically improved with aciclovir treatment. It is caused by varicella zoster virus vzv, which is a dna virus that is a member of the herpesvirus group. Treatment approaches include supportive measures, antiviral therapy, administration of varicella zoster immune globulin vzig, and management of secondary bacterial infection. The recurrent infection herpes zoster, also known as shingles has been recognized since ancient times.
Shingles is a painful vesicular eruption localized to a specific dermatome of the body. Differential diagnosis was mainly between varicellazoster virus vzv associated encephalitis versus acyclovir toxicity. Varicella zoster immune globulin pharmacokinetics absorption bioavailability. Zosterassociated encephalitis from disseminated vzv can develop within days of the disseminated rash, and should be strongly suspected in immunosuppressed patients.
Typical symptoms such as a headache, vomiting, fever and altered consciousness appear, with or without the onset of typical rash. Meningitis caused by varicella zoster virus vzv is rare in healthy population. Pdf brain stem encephalitis due to varicellazoster. The authors of the book have confined their topics to the herpes simplex viruses, varicellazoster virus, and to a. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. Varicellazoster virus and virus dna in the blood and oropharynx of people with latent or active varicellazoster virus infections. Varicella is a disease with potentially severe complications. In the majority of cases, the infection is restricted to specific dermatomes and responds. Varicella 353 22 varicella is an acute infectious disease caused by varicella zoster virus vzv. Herpes zoster shingles presents as a painful vesicular rash and is caused by reactivation of the varicellazoster virus within the dorsal root or cranial nerve ganglia. This suggests that he was no longer in the inflammatory stage of multiple sclerosis ms and had secondary progressive ms. Presents with headache and fever, but is most classically associated with an altered sensorium, and often occurs anywhere from 2 to 6 days after the onset of rash. Varicella chickenpox, one of the childhood exanthems, is caused by the human alpha herpes virus, varicella zoster. Differential diagnosis was mainly between varicella zoster virus vzv associated encephalitis versus acyclovir toxicity.
Varicellazoster virus associated encephalitis in a. Here we report a young otherwise healthy man diagnosed with a vzv meningitis without rash. Time points of blood sampling are indicated in red. One of the potential complications of this infection is involvement of the central nervous system causing encephalitis. Acute encephalitis constitutes a medical emergency. Failure to recognize occult infection may result in serious illness and.
Management of viral encephalitis guidelines the encephalitis society. The human herpesviruses include herpes simplex viruses type 1 and type 2, varicellazoster virus, cytomegalovirus and eb virus. Chickenpox is a disease caused by varicellazoster, a virus that is easily spread from one person to another by touching the open sores, sneezing or coughing. Pdf varicella zoster virus encephalitis researchgate.
A prospective cohort study was conducted from may 2011 to april 2014. Varizig is a varicella zoster immune globulin human indicated for postexposure prophylaxis in high risk individuals 1. Reactivation causes the typical dermatomal pain and vesicular rash fig 1. Vzv is a dna virus and a member of the herpes virus group.
An increased risk of this complication is associated with the immunocompromised patient. It also carries a less favorable prognosis compared to the other extracutaneous complications of vzv. Varicella chickenpox is an acute infectious disease. Neurologic complications of varicellazoster virus infection. Encephalitis is a condition of inflammation of the brain parenchyma, occurs as a result of infectious or autoimmune causes, and can lead to encephalopathy, seizures, focal neurological deficits, neurological disability, and death.
The immune system eventually eliminates the virus from most locations, but it remains dormant or latent in the ganglia adjacent to the spinal cord called. Acyclovir and disseminated varicella zoster and encephalitis. Viral causes account for the largest proportion, but in the last decade there has been growing recognition of antineuronal antibody syndromes. Only a few cases have been described in the literature, most of which involved adult or elderly patients. The patients baseline mobility was wheelchairbound, which means that his expanded disability status scale edss score2 was at least 7. Herpes zoster encephalitis is one of the most dangerous complications of varicella zoster virus infection. Potent varicella zoster virus vzvspecific bcell and cd8 tcell response in fulminant zoster encephalitis. Severe and even fatal varicella has been reported in. Varicella is characterized by fever, malaise, and a generalized pruritic, vesicular rash. Purpose the federal bureau of prisons bop clinical guidance for the management of varicella zoster virus vzv infections provides recommendations for the medical management of federal inmates with varicella chickenpox and herpes zoster shingles, as well as for. A time course of symptom onset, treatment, and hospital stay.
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