1/8. Meningoencephalomyelitis with vasculitis due to varicella zoster virus: a case report and review of the literature.Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and brown-sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/8. An unusual varicella zoster infection complicated by purpura fulminans and multiorgan failure in a healthy infant.The case is reported of a 2-y-old boy who developed purpura fulminans, meningoencephalitis, pneumonia complicated by adult respiratory distress syndrome and acute renal failure after varicella. These complications of varicella are extremely rare in a healthy infant.- - - - - - - - - - ranking = 1.5keywords = varicella (Clic here for more details about this article) |
3/8. Sequestration of virus-specific T cells in the cerebrospinal fluid of a patient with varicella zoster viral meningoencephalitis.The frequency of virus-specific T cells in the cerebrospinal fluid of a patient with viral infection of the brain and meninges was determined by using a single-T-cell cloning technique where a representative sampling of T cells was cloned from the cerebrospinal fluid of a patient with varicella zoster viral (VZV) meningoencephalitis. That the derived T-cell clones were in fact clonal was shown by demonstrating, on Southern blot analyses, unique rearrangements of the T-cell antigen-receptor beta-chain genes of each clone. Five out of the 15 of the T4 (CD4), 0/4 of the T8 (CD8), and 0/1 of the T4 T8 T-cell clones proliferated to VZV, while no clones proliferated to mumps virus or myelin basic protein. There was no clonal expansion of any VZV-reactive T cell in this patient's cerebrospinal fluid. As VZV meningoencephalitis is thought to be due to the reactivation of a dormant herpes zoster viral infection, it can be regarded as a secondary immune response. The presence of different T-cell receptor beta-chain gene rearrangements in each T-cell clone suggests that the T-cell response was polyclonal. These results demonstrate that a high frequency of polyclonal, T4 antigen-specific T cells can be found in a naturally occurring, localized, immune response.- - - - - - - - - - ranking = 1.25keywords = varicella (Clic here for more details about this article) |
4/8. Immunological diagnosis in viral infections of the central nervous system: course of antibody titres against homo- and heterologous viruses.In clinical cases suspected for viral encephalitis or meningoencephalitis, the estimation of virus-specific antibodies especially in liquor requires high sensitivity as well as specificity. With enzyme immunoassays the sensitivity in detecting antibodies has increased compared to e.g., complement fixation tests. This report concerns the determination of virus-specific antibodies with a commercial enzyme-linked immunosorbent assay (ELISA) in paired liquor/serum samples of four patients with encephalitis or meningoencephalitis. Up to six virus-specific antibodies of the IgG and IgM classes have been determined [herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus, mumps virus, measles virus, and rubella virus]. Additionally, serum samples from several patients suffering, or recovered from, diseases caused by HSV and VZV without CNS involvement have been included as controls. The results showed that besides the virus-specific antibody development (IgG and IgM) against the leading virus, i.e., principally concerned in the disease manifestation assumed to be primarily causing the disease, virus-specific antibodies of the IgG and IgM class against a heterologous virus (e.g., VZV) could also be measured with substantial titers. "Cross-reacting" antibodies to both HSV and VZV with the ELISA only appeared and were present in cases where the infection mainly affected the CNS: no such immunological "cross-reactivity" was observed in serum of individuals in "clinically silent" stages of both HSV and VZV infections. The same situation with no measurable "cross-reacting" antibodies was found in cases of acute HSV or VZV diseases where the CNS was not involved. These findings have been discussed with respect to the findings of common antigens, especially between HSV and VZV, and with respect to an unspecific stimulation of immunocompetent cells.- - - - - - - - - - ranking = 0.25keywords = varicella (Clic here for more details about this article) |
5/8. Intrathecal synthesis of virus-specific oligoclonal IgG, IgA and IgM antibodies in a case of varicella-zoster meningoencephalitis.Varicella-zoster (VZ) virus meningoencephalitis was diagnosed in a 72-year-old man without other clinical signs of VZ infection, on the basis of intrathecal virus-specific IgG, IgA and IgM antibody responses demonstrated by imprint immunofixation (IIF) and by serological analyses of serum and CSF. The intrathecally produced antibodies displayed oligoclonal characteristics. The intrathecal production of VZ-IgG and -IgA antibodies persisted throughout the observation period of 20 months, while that of VZ-IgM antibodies was not detectable later than 3 months after onset. Part of the intrathecally produced VZ-IgG and -IgA antibody populations, but no IgM antibodies, were shown to cross-react with herpes simplex virus. Oligoclonal IgG bands were demonstrated in the CSF throughout the observation period. The bulk of the IgG bands was shown to represent VZ-specific antibodies.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
6/8. Disseminated varicella-zoster virus infection with the syndrome of inappropriate antidiuretic hormone.A patient with non-Hodgkin's lymphoma who was previously treated with chemotherapy and radiotherapy was seen with intestinal pseudoobstruction due to paralytic ileus associated with herpes zoster (varicella zoster) infection. The infection was accompanied by a polydermatomal rash with typical morphologic characteristics, followed by cutaneous dissemination and the syndrome of inappropriate antidiuretic hormone (SIADH), as well as myotomal paresis. The diagnosis was supported by cytology and by culture of the virus from the CSF. The isolation of the virus from the CSF, coupled with abnormalities of the patient's mental status and CSF, indicate that meningoencephalitis occurred and probably accounted for the SIADH. The patient had a spontaneous and complete recovery. To our knowledge, this is the first report of SIADH associated with herpes zoster infection.- - - - - - - - - - ranking = 1.25keywords = varicella (Clic here for more details about this article) |
7/8. Vasculitic, hypoxic-ischemic leukoencephalopathy.The case of a 67-year-old woman with terminal renal insufficiency, who developed extensive encephalopathy with predominant involvement of the white matter is reported. The encephalopathy was the consequence of preexisting hypertensive alterations, acidosis, hypoxia, ischemia, bacteremia and varicella-zoster meningoencephalitis. The vasculitic alterations associated with meningoencephalitis had a major influence on the development and the extent of the leukoencephalopathy.- - - - - - - - - - ranking = 0.25keywords = varicella (Clic here for more details about this article) |
8/8. Successful treatment of varicella zoster virus meningoencephalitis in patients with AIDS: report of four cases and review.OBJECTIVE: Neurologic complications are common in patients with AIDS. herpes zoster is a common early manifestation of hiv infection, but there have been few reports of encephalitic complications and nearly all have been postmortem. We report four cases of varicella zoster virus (VZV) meningoencephalitis diagnosed and treated antemortem, and briefly review the relevant literature. SETTING: Mount Zion Medical Center, san francisco, california, USA. patients: Four hiv-positive male patients with antibodies to VZV in their cerebrospinal fluid. INTERVENTION: Treatment with intravenous acyclovir (three cases) and intravenous ganciclovir (one case), which resulted in resolution of all symptoms except blindness in one patient. CONCLUSION: antibodies to VZV in the cerebrospinal fluid of hiv-positive individuals may allow early diagnosis and lifesaving treatment of VZV meningoencephalitis.- - - - - - - - - - ranking = 1.25keywords = varicella (Clic here for more details about this article) |