Since mollarets meningitis is a recurrent, benign noncancerous, aseptic meningitis, it is also referred to as benign recurrent lymphocytic meningitis. A 15yearold immunocompetent girl with background of wellcontrolled graves disease presented with 3 days of fever, frontal headache, terminal neck stiffness and photophobia. Fewer than 4% of patients have another outbreak of zoster, but many, particularly older patients, have persistent. Objectives and methods as early diagnostic detection is mandatory to prevent longterm sequelae, any clinical indication is helpful to identify patients that are at higher risk of the development of. Varicella zoster virus meningitis with hypoglycorrhachia. Jul 15, 2012 the risk of herpes zoster recurrence following a recent initial episode is fairly low among immunocompetent adults, regardless of vaccination status. Here we report a young otherwise healthy man diagnosed with a vzv meningitis without rash. Herpes zoster results from reactivation of the va ricella zoster virus. Etiologic agent herpes zoster shingles is caused by the same virus as chickenpox, the varicella zoster virus vzv. Herpes simplex and varicella zoster cns infections. To describe the clinical manifestations, cerebrospinal fluid csf characteristics, imaging studies and prognostic factors of adverse clinical outcomes aco among adults with herpes simplex virus hsv or varicella zoster virus vzv cns infections. This virus can be spread by sexual contact or from an. Pdf risk factors for aseptic meningitis in herpes zoster.
Background acute meningoencephalitis me from varicella zoster virus vzv reactivation is a rare and serious complication of herpes zoster hz. Herpes zoster ophthalmicus is a latent vzv infection involving the ophthalmic division of the trigeminal nerve. Varicellazoster virus vzv infection causes varicella and results in latent infection in the sensory ganglia. The objective of this article is to provide evidencebased recommendations for the management of patients with herpes zoster.
Cerebrospinal fluid csf examination revealed the presence of vzv dna, antivzv immunoglobulin g igg antibody, and. We report varicella zoster virus vzv meningitis in a healthy adult woman with no antecedent rash and with hypoglycorrhachia. Thus, populationbased data on incidence and complications of hz are needed. Subsequent laboratory studies of the virus led to the development of a. Varicella zoster meningoencephalitis following treatment. Such a low risk suggests that one should evaluate the necessity of immediately vaccinating immunocompetent patients who had a recent herpes zoster episode. The chickenpox virus is also called varicella zoster. Estudio epidemiologico nacional sobre herpes zoster en espana. Herpes meningoencephalitis is an infection of the brain and brain covering meninges caused by the herpes simplex virus. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. The impact of herpes zoster and postherpetic neuralgia on. 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. Abstract herpes zoster hz results from the reactivation of the varicella zoster virus latent in the sensory ganglia when cellmediated immunity is altered. Herpes zoster infections are frequently observed after allogeneic bone marrow transplantation allobmt.
It is a frequent condition in older adults, leading to undesirable adverse outcomes. Phn may last a year or longer after the episode of zoster. This case describes an uncommon presentation of herpes zoster in an adolescent with viral meningitis and concomitant genital shingles. Su complicada posologia lo relega solo a tratamientos intravenosos en casos complicados. A case of meningitis due to varicella zoster virus. More than 90% of adults in the united states have serologic evidence of vzv infection. The development of neurological complications due to varicella zoster virus vzv reactivation is relatively uncommon, particularly in the case of immunocompetent patients. Encephalitis is caused by the herpes simplex virus.
Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. A viral prodrome is common, including headache, malaise, and photophobia. Varicella virus is a neurotropic virus that can reactivate later in life to cause zoster or shingles. Symptoms can include headache, fever, changes in consciousness, confusion, neck stiffness, sensitivity to light, seizures, and changes in mood, personality, or. The clinical course of herpes zoster, in patients of primary health care and younger than 60 years of age, is beningn and without complications. O herpeszoster hz e uma doenca infecciosa relativamente comum provocada pela reativacao do vvz caracterizada por manifestacoes cutaneas dolorosas 36. This was preceded by 4 days of pain and itch over vaginal and anal region. Approximately 1 mil lion new cases of zoster occur in the united states annu ally. Background herpes zoster hz is caused by reactivation of latent varicellazoster virus vzv infection. The frequency of hz among children who receive varicella vaccine is uncertain, although some experts have suggested that it is much lower than the. Por tanto, e muito importante prevenir, diagnosticar e tratar precocemente o hz e suas complicacoes. Herpes zoster vaccine and the incidence of recurrent herpes. Pain is the predominant symptom in all phases of hz disease, being reported by up. The appropriate treatment was indicated and either the lesions or the associated symptoms disappeared.
Herpes zoster is caused by reactivation of the varicella zoster virus the cause of chickenpox from its latent phase. Mollarets meningitis is a recurrent or chronic inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Shingles, or herpes zoster, is a painful rash caused by the chickenpox virus. A painful rash, usually crops of vesicles on an erythematous base, develops on one or more adjacent dermatomes. Risk factors for aseptic meningitis in herpe s zoster patients article pdf available in annals of dermatology 293. Herpes zoster with skin lesions and meningitis caused by 2. The main com plication of herpes zoster is the postherpetic neu. One in four people will contract herpes zoster in their lifetime, with this risk rising markedly after the age of 50 years, and affecting one in two in elderly individuals. Herpes zoster hz caused by reactivation of latent vaccinestrain varicella zoster virus vzv in sensory ganglia constitutes an additional, usually late, complication of varicella vaccination. Varicella outbreak control guidelines july 2014 page 1 of 14 varicella outbreak control guidelines infectious agent virus.
The most common symptoms are fever, headache, and neck stiffness. Viral meningitis may be suspected on the basis of epidemiologic data, clinical features, and initial cerebrospinal csf studies, but clinical features cannot reliably differentiate viral from bacterial meningitis. Most are caused by herpes simplex virus type 1 hsv1, the virus that also causes cold sores. Herpes zoster is characterized by a painful, unilateral vesicular eruption, which usually occurs in a restricted dermatomal distribution.
We previously reported that reactivation of vzv caused herpes zoster hz in all age groups, especially in the elderly, at rates of 38 per personyears in a study of 48 388 patients with hz. Herpes zoster is caused by the reactivation of the latent varicellazoster virus. Caso clinico varicela y herpes zoster en una paciente con. Image courtesy of the centers for disease control and prevention. Vzv was isolated from vesicular fluid of both chickenpox and zoster lesions in cell culture by thomas weller in 1954. Herpes zoster with progression to acute varicella zoster.
This book focuses on the similarities in tissue tropisms and character of the lesions of the two viruses. The incidence of herpes zoster hz is increasing and poses a significant health concern to aging populations. Clinical manifestations and treatment provides an authoritative and updated clinical observation on two viruses herpes simplex varicella and zoster. Herpes zoster can occur at any age but most commonly affects the elderly population. A viral prodrome is common, including headache, malaise, and photophobia followed by pain. Recommendations for the management of herpes zoster. The virus has the capacity to persist in the body as a latent infection after the primary. Two days after his pediatrician had diagnosed herpes zoster and prescribed oral acyclovir 400 mg three times a.
Typically, it affects elderly, immunocompromised population. It is more commom in elderly and inmunocompromised patients. The previously dormant virus travels from the dorsal root ganglion and down the sensory nerves to the skin to cause the classic single, unilateral dermatome rash that is typically associated with a shingles infection. Herpes zoster encephalitis an overview sciencedirect.
The potential manifestations include chickenpox, herpes zoster, postherpetic neuralgia, aseptic meningitis and encephalitis, ramsay hunt syndrome, and herpes ophthalmicus. The reactivated vzv may travel down the ophthalmic division to the nasociliary nerve, which innervates the tip of the nose and surface of the globe of the eye. Herpes viruses are the other common cause of viral meningitis in adolescents and adults in developed countries2. It is a medical emergency that requires treatment right away. Approximately one in three persons in the general population will develop zoster during their lifetime. Varicella meningitis with concomitant genital shingles in. Varicella can infrequently lead to encephalitis resulting in seizures and coma estimated. Hzassociated aseptic meningitis, a rare complication of hz, can require hospitalization and a long treatment period. It was named for pierre mollaret, the french neurologist who first described it. Several studies suggest an increased risk of stroke following zoster infection, but the results are conflicting. Herpes zoster and recurrent herpes zoster open forum. Charleston, sc as is the case with herpes simplex, the diverse array of remedies proposed for herpes zoster hz raises doubts as to their overall efficacy. Complications of herpes zoster in children kanamori.
Herpes zoster vaccine and the incidence of recurrent herpes zoster in an immunocompetent elderly population article in the journal of infectious diseases 2062. Rapid antiviral therapy initiated within 72 h of rash onset has been shown to accelerate rash healing, reduce the duration of acute pain and, to some extent, attenuate the development and duration of phn. Varicella zoster virus is responsible for about 11% of those cases. A case of disseminated zoster in an immunocompetent patient.
Varicellazoster virus reactivation leads to herpes zoster the main complication of which is postherpetic neuralgia phn. The disease may also be caused by herpes virus type 2 hsv2. Herpes viruses include the herpes simplex viruses hsvs and varicella zoster virus the same virus that causes chickenpox and shingles. Incidence of herpes zoster and associated events including. Postherpetic neuralgia phn, defined as pain persisting more than 3 months after the rash has healed, is a debilitating and difficult to manage consequence of hz. Herpes zoster is caused by the reactivation of the latent varicella zoster virus. 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. Only a few cases have been described in the literature, most of which involved adult or elderly patients. Mar 15, 2012 varicella zoster virus vzv is increasingly recognized as an important etiology of sporadic viral meningoencephalitis me. The epidemiology, clinical manifestations, diagnosis, and prevention of herpes zoster are discussed elsewhere. Nov 29, 2019 risk for zoster up before diagnosis, during treatment of hematologic cancer. Varicella zoster virus vzv, a member of the herpes virus group clinical manifestations primary infection chickenpox symptoms prodrome o a. More detailed understanding of herpes zoster hz is called for in the context of an increasing observed frequency of disease, and ongoing discussions regarding potential consequences of the disease.
Mullooly jp, riedlinger k, chun c, weinmann s, houston h. Cuba 20012003 2001 2002 2003 provincias casos tasas casos tasas casos tasas. Although herpes zoster can occur at any age, it is mainly a disease of adults 60 years of age. Shingles herpes zoster 2 shingles herpes zoster 1 the disease and its epidemiology i. The potentially serious nature of herpes zoster hz and the longterm complication postherpetic neuralgia phn are often underestimated. Introduction varicellazoster virus vzv is a herpes virus causing varicella, which latently persists in the nervous system through. We report an unusual case of an immunocompetent young adult presenting with occipital headache and zoster rash, without preherpetic and postherpetic neuralgia, who was diagnosed with varicella meningitis on polymerase chain. He complained of acute headache, nausea, and vomiting. Furthermore, mild cases of herpes simplex virus hsv me, traditionally considered a devastating infection, are frequently reported.
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