Herpes zoster and meningitis in an immunocompetent child. Varicella zoster virus meningitis in a young immunocompetent. The purposes of this study were to investigate the clinical course and visual outcome, and to determine if the choice of a systemic antiviral therapy. Bacterial meningitis management and treatment cleveland. Infection of the central nervous system caused by varicella zoster.
Guidance for management of varicella and herpes zoster in healthcare settings background varicella chickenpox is a highly contagious viral illness caused by the varicella zoster virus vzv characterized by a diffuse generalized and usually pruritic maculo papulovesicular rash. Management of varicella zoster virus retinitis in aids. Viral meningitis is a virusborne inflammation of the meninges, which are the. Only a few cases have been described in the literature, most of which involved adult or elderly patients. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose. Diagnosis of varicella zoster virus meningitismeningoencephalitis by the. Primary infection with vzv results in chickenpox, also known as varicella. The yield of testing for hiv was shown in one report from north carolina where stored csf samples from 57 patients who had presented with non. Vzv infection of the central nervous system cns such as encephalitis, meningitis, myelitis, or angiitis occurs less frequently but is feared because of the numerous unfavourable outcomes 1, 3, 4. Usually cns infection with vzv comes along with dermal affection but can rarely develop without rash 1, 3, 510. A general intravenous antibiotic with a corticosteroid to bring down the inflammation may be prescribed even before all the test results are in. 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. Varicella can infrequently lead to encephalitis resulting in.
Meningitis is a serious infection of the meninges in the brain or spinal cord that is most commonly viral or bacterial in origin, although fungal, parasitic, and noninfectious causes are also possible. A case of meningitis due to varicella zoster virus reactivation in an. The recommended dose of intravenous acyclovir for vzv infections is 10 mgkg every 8 hours, although higher doses 1215 mgkg are sometimes used for lifethreatening infections, especially in immunocompromised patients. Like other herpesviruses, vzv has the capacity to persist in the body after the primary first infection as a latent infection. Given the favourable evolution of the illness, the child was discharged without further therapy after the 10day treatment. Diagnosis, initial management, and prevention of meningitis. Aseptic meningitis often has a similar presentation to that of bacterial meningitis ie, fever, headache, altered mental status, stiff neck, photophobia, which can be a lifethreatening illness.
A case of meningitis due to varicella zoster virus. Enteroviruses and herpes simplex virus are the leading causes of viral meningitis, while neisseria meningitidis and streptococcus pneumoniae are the pathogens. Epidemiology of bacterial meningitis in the usa from 1997 to 2010. Adults with herpes zoster can be treated with oral acyclovir at a dose of 800 mg five times daily. In addition, neurological complications such as meningitis resulting from vzv are considered a rare entity.
Vzv, which causes chickenpox varicella, may reactivate to cause shingles herpes zoster. Both parasites and fungi can cause meningitis, but these type of infections are not common. Risk factors for aseptic meningitis in herpes zoster patients article pdf available in annals of dermatology 293. Viral meningitis is most commonly caused by the enteroviruses and is self. Meningitis with polymerase chain reaction for varicella. From this case report we suggest that varicella zoster virus. Herpes zoster encephalitis an overview sciencedirect. An atypical form of vzv infection, disseminated hz has been described primarily in immunocompromised hosts. Introduction varicellazoster virus vzv is a highly contagious virus. Chickenpox for healthcare professionals varicella cdc. Varicella zoster meningitis, optic neuritis preceding the.
It is caused by varicellazoster virus vzv, which is a dna virus that is a member of the herpesvirus group. Aimsbackground varicella zoster virus retinitis vzvr in patients with aids, also called progressive outer retinal necrosis porn, is a necrotising viral retinitis which has resulted in blindness in most patients. However, in contrast to bacterial meningitis, many patients with aseptic meningitis particularly those who have disease caused by viruses or. Incidence, aetiology, and sequelae of viral meningitis in. In the past 1015 years, viral meningitis has been recognised increasingly, and can be a substantial cause of morbidity. Hypoglycorrhachia and elevated csf protein concentra. Traditionally vzv meningitis has been treated with iv acyclovir in accordance with the infectious disease society of america idsa treatment.
Management of viral encephalitis guidelines cover the initial management of all patients with suspected encephalitis, up to the point of diagnosis, in an acute care setting such as acute medical unit or emergency department. In conclusion, even young immunocompetent patients without rash might present with vzv meningitis. Varicella chickenpox is an acute infectious disease. Varicella zoster virus polymerase chain reaction pcr is the method of choice for diagnosis of varicella. In addition, vzv associated meningitis can present with or without the typical vesicular dermatomal rash. Primary infection caused by varicellazoster virus vzv is manifest by varicella chickenpox, while reactivation of latent virus causes herpes zoster shingles. Varicellazoster virus chickenpox and shingles protocol 1. Recommendations for the management of herpes zoster. 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. The epidemiology, pathogenesis, clinical manifestations, diagnosis, and differential diagnosis are discussed separately.
Management of herpes simplex and varicellazoster infections. We present a case of a fortynineyearold female patient with acquired immunodeficiency syndrome aids who presented with headache, fever, and blurred vision. Antiviral therapy of varicellazoster virus infections. Etiologies and management of aseptic meningitis in patients admitted to an internal medicine department. Varicellazoster virus infection vzv causes two major diseases. In immunocompetent children, varicella is usually not a serious disease, but can cause severe morbidity and mortality in adults and in immunocompromised individuals. Definition and management of varicella zoster virus. Shukla b, aguilera ea, salazar l, wootton sh, kaewpoowat q, hasbun r. Meningitis is a rare complication of primary infection and is.
Varicella zoster virus vzv is an exclusively human virus primarily causing chickenpox. Review of 180 patient admitted to im unit with aseptic meningitis, including 124 without encephalitis. Epidemiology, pathogenesis, and etiology in children and viral meningitis. Meningitis caused by varicella zoster virus vzv is rare in healthy population. Viral meningitis is the most common form of meningitis. We report a case of vdvzv contracted during immunosuppressive therapy for membranous nephropathy. When the specific bacteria are identified, your doctor may decide to change antibiotics.
The natural history of vzv meningitis and the role of antiviral therapy are poorly defined. Meningitis knowledge for medical students and physicians. Reactivation of latent varicellazoster virus vzv infection most commonly manifests as herpes zoster. Since the widespread introduction of conjugate vaccines against haemophilus influenzae type b in 1992, neisseria meningitidis serogroup c in 1999, and streptococcus pneumoniae in 2002, the incidence of communityacquired bacterial meningitis. Meningitis occurs when the membranes that cover the brain and spinal cord become inflamed. Management of herpes simplex and varicellazoster infections peter muir phd. After a primary varicellazoster virus vzv infection termed varicella or chickenpox, the virus establishes latency in dorsal root and cranial nerve ganglia. After the primary infection, vzv stays in the body in the sensory nerve ganglia as a latent infection. Meningitis is an infection of the meninges, the membrane covering the brain. Meningitis caused by varicella zoster virus vzv is quite rare among young immunocompetent adults though immunocompromised patients are often seen to be affected by reactivation of vzv presenting with primary clinical features of dermatomal rashes and neurological sequelae.
Viral meningitis excluding hsv and vzv meningitis, where protein may be. Individuals with weakened immune systems may be at increased risk of these diseases. Development of neurological complications of varicella zoster virus reactivation is relatively. Guidance for management of varicella and herpes zoster in. Clinical course and outcomes of varicellazoster virus meningitis. It can be treated with appropriate antibiotics that also prevents spread. Bacterial meningitis is very serious because its onset is rapid and the infection is associated with a significant risk of death. In most cases, the presence of focal neurological signs and focal seizures will distinguish encephalitis from encephalopathy.
Vzv is a dna virus and is a member of the herpesvirus group. Use of highdose oral valacyclovir during an intravenous. In a previous study the incidence of vzv meningitis among 859 adults with hz was found to be 0. Nevertheless, the use of acyclovir 510 mgkg intravenous iv every 8 h for 10 14 days is. Vzv may also be isolated in tissue culture, although this is less sensitive and requires several days to obtain a result. Here we report a young otherwise healthy man diagnosed with a vzv meningitis without rash. Viral meningitis accounts for approximately 26,000 to 42,000 hospitalizations each year in the united states, affecting mainly infants younger than one year, children 510 years of age, and the immunocompromised. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. Csf pleocytosis with a positive culture and symptoms of infection are indicative of a diagnosis of healthcareassociated ventriculitis or meningitis strong, high. Excluding hsv and vzv meningitis, where protein may be. At the end of the guidelines the special circumstances of returned travellers, immunocompromised patients and antibodyassociated encephalitis are discussed. The optimal therapy for meningitis with varicella zos. Cerebrospinal fluid csf analysis was consistent with vzv meningitis.
With chickenpox, vzv disseminates to the nervous system, where it remains dormant. Acute encephalitis constitutes a medical emergency. Varicella outbreak control guidelines july 2014 page 3 of 14 o serious complications have rarely been reported in breakthrough disease among persons who developed idsa standards and practice guidelines committee collaborated with partner organizations to convene a panel of 10 experts on healthcareassociated ventriculitis and meningitis. Infection with varicella zoster virus vzv causes varicella chickenpox, which can be severe in immunocompromised individuals, infants and adults. The management, prognosis, and prevention of viral meningitis in children will be discussed here. Vzv meningitis was previously considered to be a rare cause of aseptic meningitis due to the lack of appropriate detection tests.
This article will focus on diagnostic and management issues that a. Bacterial meningitis excluding listeria meningitis, where csf leukocytes are often 20. Reactivation of the varicellazoster virus vzv causes dermatomal herpes zoster hz and more rarely severe disseminated hz including diffuse rash, encephalitis, hepatitis, and pneumonitis. The latter is favored by advanced age or immunosuppression but can also occur in immunocompetent individuals 48. Acute disseminated encephalomyelitis is a noninfective inflammatory encephalitis that may require to be treated with steroids. Viral meningitis usually gets better within a couple of weeks, with plenty of rest and painkillers for the headache. Successful management of visceral disseminated varicella. After a latency period in ganglionic neurons, vzv can reactivate and cause herpes zoster hz. This is normally caused by infection but can also have noninfectious causes. Herpes zoster hz, also known as shingles, results from reactivation of vzv and its spread from a single ganglion to the neural tissue of the affected segment and the corresponding cutaneous dermatome 1. Varicellazoster meningitis in an immunocompetent young.
Visceral disseminated varicella zoster virus vdvzv infection is a rare disease with a high mortality rate 55% in immunocompromised patients, but it is not yet widely recognized in the field of nephrology. Download a pdf of the management of suspected viral encephalitis in adults. Two days after his pediatrician had diagnosed herpes zoster and prescribed oral acyclovir 400. Pharmacokinetic data suggest similar serum concentrations to iv acyclovir doses can be achieved with hdva 6, 7. Pdf definition and management of varicella zoster virus. Pdf risk factors for aseptic meningitis in herpes zoster. The development of neurological complications due to varicella zoster virus vzv reactivation is relatively uncommon, particularly in the case of immunocompetent patients. Varicella zoster virus centers for disease control and. Varicella zoster virus is responsible for about 11% of those cases. Its typically mild and goes away without treatment. Varicellazoster virus vzv has been known to cause various eye disorders in both immunocompetent and immunocompromised patients.
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