Varicella (Herpes) Zoster Meningitis

8/07/02

Question: What are aspects of meningeal disease caused by varicella zoster, especially in HIV patients?

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Unique Identifier:11236108

Authors: Brown M. Scarborough M. Brink N. Manji H. Miller R.

Institution: Department of Sexually Transmitted Diseases, Windeyer Institute of Medical Sciences, Royal Free and University College Medical School, University College London, UK.

Title: Varicella zoster virus-associated neurological disease in HIV-infected patients.

Source: International Journal of STD & AIDS. 12(2):79-83, 2001 Feb.

Abstract: Varicella zoster virus (VZV) is an uncommon but well recognized cause of neurological disease in HIV-infected patients. Analysis of cerebrospinal fluid (CSF) using the polymerase chain reaction (PCR) in HIV-infected patients presenting with neurological disease has increasingly allowed diagnosis of VZV-associated pathology. We report clinical, radiological and virological data from 15 consecutive patients with VZV-associated neurological disease. Clinical presentation was varied, including meningo-encephalitis in 9 and isolated cranial nerve palsies in 6. VZV deoxyribonucleic acid (DNA) was detected by PCR in CSF of 11/15; pleocytosis was present in only 6/15, raised protein in 11/15. Magnetic resonance imaging (MRI) appearances were focal signal abnormalities in 8, meningeal enhancement in 2 and normal in 2. With specific anti-VZV therapy 10 patients recovered fully. The predictive value of PCR on CSF for diagnosis of VZV-associated neurological disease should take into account the patient's clinical presentation, concurrent infections and response to anti-VZV therapy. CAS Registry/EC Number 0 (Antiviral Agents). 0 (DNA, Viral).