head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2020, vol. 26, issue2
Subject Area: Medicine
DOI: 10.5272/jimab.2020262.3053
Published online: 02 April 2020

Case report

J of IMAB. 2020 Apr-Jun;26(2):3053-3056
Zhivka Stoykova1, 2ORCID logo Corresponding Autoremail, Tsvetelina Kostadinova1, 3ORCID logo, Radka Argirova4ORCID logo,
1) Laboratory of Virology,” St. Marina” University Hospital – Varna, Bulgaria
2) Department of Microbiology and Virology, Medical University of Varna, Bulgaria
3) Medical College, Medical University of Varna, Bulgaria
4) Clinical Laboratory, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria.

Background: Varicella zoster virus (VZV) is a widespread herpes virus that causes chickenpox after primary infection. Later the virus remains persistent in the sensory nerve ganglia, and it can be reactivated with the manifestation of herpes zoster most often. But reactivation of VZV can manifest as infection of the CNS (central nervous system) even in an immunocompetent host. The detection of VZV Ab by ELISA and VZV-DNA in cerebrospinal fluid by PCR has improved the laboratory conformation of that condition in an immunocompetent host with discreet exanthema.
Materials and Methods: Two serum samples and three CSF samples of a patient with aseptic meningitis were tested by ELISA and PCR.
Interpretation: This clinical case demonstrates that VZV may be considered in all cases of aseptic meningitis even in immunocompetent individuals without the typical rash. In cases under VZV associated meningitis suspicion, the first detection marker to be positive is VZV-DNA and later anti-VZV IgG in CSF.

Keywords: VZV, VZV reactivation, VZV-DNA in CSF, aseptic meningitis,

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Please cite this article as: Stoykova Z, Kostadinova T, Argirova R. Varicella zoster virus associated aseptic meningitis in an immunocompetent patient. J of IMAB. 2020 Apr-Jun;26(2):3053-3056. DOI: 10.5272/jimab.2020262.3053

Corresponding AutorCorrespondence to: Zhivka Stoykova, Laboratory of Virology, University Hospital St. Marina, Varna; 1, Hristo Smirnenski Blvd., 9010, Varna, Bulgaria; E-mail: jivita77@abv.bg

1. Mueller NH, Gilden DH, Cohrs RJ, Mahalingam R, Nagel MA.Varicella zoster virus infection: clinical features, molecular pathogenesis of disease and latency. Neurologic Clinics. 2008 Aug;26(3):675-97. [PubMed] [Crossref]
2. Gupta P, Ranjan R, Agrawal CS, Muralikrishnan K, Dave N, Rana DS. Meningitis with polymerase chain reaction for varicella zoster positivity in cerebrospinal fluid of a young immunocompetent adult. J Neurosci Rural Pract. 2016; 7(4):591-593. [Crossref]
3. Kupila L, Vuorinen T, Vainionpaa R, Hukkanen V, Marttila RJ, Kotilainen P. Etiology of Aseptic Meningitis and Encephalitis in an Adult Population. Neurology. 2006 Jan 10;66(1):75-80. [PubMed] [Crossref]
4. Kahraman H, Tünger A, Şenol Ş, Gazi H, Avcı M, Örmen B, et al. [Investigation of Bacterial and Viral Etiology in Community Acquired Central Nervous System Infections With Molecular Methods] [in Turkish] Mikrobiyol Bul. 2017 Jul;51(3):277-285.  [PubMed] [Crossref]
5. Koskiniemi M, Rantalaiho T, Piiparinen H, von Bonsdorff CH, Färkkilä M, Järvinen A, et al. Infections of the central nervous system of suspected viral origin: a collaborative study from Finland. J Neurovirol. 2001 Oct;7(5):400-8.[PubMed] [Crossref]
6. Frantzidou F, Kamaria F, Dumaidi K, Skoura L, Antoniadis A, Papa A. Aseptic Meningitis and Encephalitis Because of Herpesviruses and Enteroviruses in an Immunocompetent Adult Population. Eur J Neurol. 2008 Sep;15(9):995-7. [PubMed] [Crossref]
7. Pasedag T, Weissenborn K,  Wurster U, Ganzenmueller T,  Stangel M, Skripuletz T. Varicella Zoster Virus meningitis in a young immunocompetent adult without rash: A Misleading Clinical Presentation. Case Reports in Neurological Medicine. 2014; 2012:686218. [PubMed] [Crossref]
8. DeBiasi RL, Kleinschmidt-DeMasters BK, Weinberg A, Tyler KL. Use of PCR for the Diagnosis of Herpesvirus Infections of the Central Nervous System. J Clin Virol. 2002 Jul;25(Suppl 1):S5-11. [PubMed] [Crossref]
9. Nagel MA, Forghani B, Mahalingam R, Wellish MC, Cohrs RJ, Russman AN, et al. The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy. Neurology. Mar 2007 Mar;68(13):1069-73.[PubMed] [Crossref]
10. Gershon A, Steinberg S, Greenberg S, Taber L. Varicella-Zoster-Associated Encephalitis: Detection of Specific Antibody in Cerebrospinal Fluid. J Clin Microbiology. 1980 Dec;12(6):764-7. [PubMed] [Crossref]

Received: 24 June 2019
Published online: 02 April 2020

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