水痘带状疱疹病毒(VZV)是一种嗜神经性α疱疹病毒,可作为原发感染或再激活的并发症引起神经系统表现。VZV诱导的神经系统疾病在早期证实并采用抗病毒治疗时具有良好的预后。脊髓炎,脑炎,在免疫功能正常和免疫功能低下的个体中,脑室炎或脑膜炎可以在没有明显皮疹的情况下发生,从而使诊断变得困难。我们分析了30名未接种疫苗的研究参与者(17名男性和13名女性)的CSF和血清样本,以通过PCR确定CSF中VZVDNA的存在,并评估有/无皮疹神经系统表现的参与者的血清和CSF抗VZVIgG和白蛋白水平。在儿童和成人参与者的CSF(n=22,[73%])和血清(n=29,[97%])中检测到抗VZVIgG。在具有不同临床表现的感觉改变的参与者的CSF中检测到抗VZVIgG(n=8,[36%]),脑膜炎(n=4,[18%]),急性高热性疾病(n=3,[14%],脑病/脑膜脑炎(n=2,[9%]),易怒(n=2,[9%])和每位脑血管卒中患者,脱髓鞘障碍和高热惊厥(n=1,[4.5%])。从一名参与者中检测到VZVDNA,53%的研究参与者的CSF血清白蛋白水平升高。VZVDNA在疾病发作后1-2周内存在,之后,抗VZV抗体可能是疾病的唯一指标,因此VZVDNA和抗VZVIgG都需要在CSF中进行测试。由于VZVDNA和VZVIgG抗体都是VZV再激活的良好指标,通过早期发现疾病和抗病毒治疗,常规检测将降低发病率和死亡率。
Varicella zoster virus (
VZV) is a neurotropic alphaherpesvirus that causes neurological manifestations either as a complication of primary infection or reactivation.
VZV induced neurological diseases have a good prognosis when confirmed early and treated with anti-viral therapy. Myelitis, encephalitis, ventriculitis or meningitis can occur without a telltale rash in immunocompetent and immunocompromised individuals making the diagnosis difficult. We analyzed CSF and serum samples from 30 unvaccinated study participants (17 male and 13 female) to determine the presence of VZV DNA by PCR in CSF and to estimate serum and CSF anti-VZV IgG and albumin levels in participants with neurological manifestations with/without rash. Anti-VZV IgG was detected in CSF (n = 22, [73%]) and serum (n = 29, [97%]) of pediatric and adult participants. Anti-VZV IgG were detected in CSF of participants with varied clinical presentation altered sensorium (n = 8, [36%]), meningitis (n = 4, [18%]), acute febrile illness (n = 3, [14%], encephalopathy/meningoencephalitis (n = 2, [9%]), irritability (n = 2, [9%]) and each patient from cerebrovascular stroke, demyelinating disorder and febrile seizure (n = 1, [4.5%]). VZV DNA was detected from one participant and CSF serum albumin levels were elevated in 53% of study participants.
VZV DNA is present up to 1-2 weeks post onset of disease, after which anti-
VZV antibody may be the only indicator of disease and therefore both
VZV DNA and anti-
VZV IgG need to be tested for in CSF. As
VZV DNA and
VZV IgG antibody are both good indicators of
VZV reactivation, routine testing would result in reduced morbidity and mortality by early detection of disease and antiviral treatment.