Varicella-Zoster virus infections of the nervous system: clinical and pathologic correlates.
ABSTRACT Diseases that present with protean manifestations are the diseases most likely to pose diagnostic challenges for both clinicians and pathologists. Among the most diverse disorders caused by a single known toxic, metabolic, neoplastic, or infectious agent are the central and peripheral nervous system complications of varicella-zoster virus (VZV).
The pathologic correlates of the neurologic complications of VZV infection, as well as current methods for detecting viral infections, are discussed and presented in pictorial format for the practicing pathologist.
Varicella-zoster virus causes chickenpox (varicella), usually in childhood; most children manifest only mild neurologic sequelae. After chickenpox resolves, the virus becomes latent in neurons of cranial and spinal ganglia of nearly all individuals. In elderly and immunocompromised individuals, the virus may reactivate to produce shingles (zoster). After zoster resolves, many elderly patients experience postherpetic neuralgia. Uncommonly, VZV can spread to large cerebral arteries to cause a spectrum of large-vessel vascular damage, ranging from vasculopathy to vasculitis, with stroke. In immunocompromised individuals, especially those with cancer or acquired immunodeficiency syndrome, deeper tissue penetration of the virus may occur (as compared with immunocompetent individuals), with resultant myelitis, small-vessel vasculopathy, ventriculitis, and meningoencephalitis. Detection of the virus in neurons, oligodendrocytes, meningeal cells, ependymal cells, or the blood vessel wall often requires a combination of morphologic, immunohistochemical, in situ hybridization, and polymerase chain reaction (PCR) methods. The PCR analysis of cerebrospinal fluid remains the mainstay for diagnosing the neurologic complications of VZV during life.
Varicella-zoster virus infects a wide variety of cell types in the central and peripheral nervous system, explaining the diversity of clinical disorders associated with the virus.
- SourceAvailable from: Tomasz Jerzy Dzieciątkowski[Show abstract] [Hide abstract]
ABSTRACT: Clinical involvement of the central nervous system (CNS) is an unusual manifestation of human viral infection. The spectrum of brain involvement and the outcome of the disease are dependent on the specific pathogen, the immunologic state of the host, and environmental factors. Most human viruses can cause serious neurological disease of the central nervous system, either during primary infection or in the course of virus reactivation from latently infected tissue. DNA viruses cause diseases of the CNS, which can be classified into three groups: acute infections, acute post-exposure syndromes and chronic diseases. This article presents current knowledge about epidemiology and clinical presentation of DNA virus infections in the central nervous system.Postepy Mikrobiologii 12/2013; 52(4):343-347. · 0.21 Impact Factor
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ABSTRACT: : Study Design: Case report.Objective: To report this rare Varicella Zoster Virus (VZV) complication in a multiple sclerosis patient.Summary of Background Data: Longitudinally extensive transverse myelitis (LETM) is a spinal cord lesion that extends over 3 or more vertebral segments. A common feature in neuromyelitis optica, LETM can also occur in several other diseases.Methods: A 15 year-old boy with relapsing-remitting Multiple Sclerosis, who has been treated with immunomodulators for 6 months, developed a subacute left brachio-crural hemiparesis with ipsilateral decreased sensation in the trunk and limbs. This was interpreted as a new relapse, and was treated consequently. During the evolution, the patient developed a cutaneous rash in the left C8 metameres followed by asymmetric tetraparesis.Results: MRI demonstrated an extensive cervical-thoracic medullar lesion. Cerebrospinal fluid (CSF) analysis revealed 17 leukocytes /μL (95% mononuclear), protein 41 mg/dL, negative VZV-DNA by polymerase chain reaction, but elevated anti-VZV IgG CSF/serum index, with a normal albumin CSF/serum index, all of which were consistent with intrathecal synthesis of anti-VZV antibody. We were able to rule out all other causes included in the differential diagnosis, namely, vascular disease, tumor, and autoimmune conditions, especially those associated with NMO spectrum disorders.Conclusions: Awareness of the potentially varied presentation of VZV myelitis can enable earlier recognition and specific treatment.Spine 09/2013; 38(20):E1282-4. · 2.16 Impact Factor
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ABSTRACT: Inflammatory brain diseases (IBrainDs) are a leading cause of devastating neurological deficits or neuropsychiatric syndromes in previously healthy children. The spectrum is expanding rapidly and new disease entities have been discovered in the last decade. IBrainD can occur as a primary disease or may occur secondary to an underlying cause. This review focuses on the clinical presentation, diagnostic features, pathology and histology characteristics and treatment of the primary childhood IBrainDs.Rheumatology (Oxford, England) 12/2013; · 4.24 Impact Factor