Varicella-zoster virus (VZV) DNA in serum of patients with VZV central nervous system infections

• Published in: The Journal of infection Vol. 73; no. 3; pp. 254 - 260
• Main Authors: Grahn, Anna, Bergström, Tomas, Runesson, Jim, Studahl, Marie
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; arteries; Central nervous system (CNS) infections; Central Nervous System Viral Diseases - diagnosis; Central Nervous System Viral Diseases - virology; cerebrospinal-fluid; Child; Child, Preschool; clinical-manifestations; contralateral; disease; DNA, Viral - blood; Encephalitis; Encephalitis, Varicella Zoster - diagnosis; Encephalitis, Varicella Zoster - virology; Female; hemiplegia; Herpes Zoster - cerebrospinal fluid; Herpes Zoster - diagnosis; Herpes Zoster - virology; herpes-zoster; Herpesvirus 3, Human - genetics; Herpesvirus 3, Human - isolation & purification; Humans; Infectious Disease; Infectious Diseases; Infectious Medicine; Infektionsmedicin; Male; Middle Aged; Polymerase chain reaction (PCR); quantitation; Real-Time Polymerase Chain Reaction - methods; Varicella zoster virus (VZV); vasculopathy; Viral Load; Young Adult; Central nervous system (CNS) infections; Encephalitis; Varicella zoster virus (VZV); Polymerase chain reaction (PCR)
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2016.04.035

Summary Objectives Varicella-zoster virus (VZV) is a common viral agent causing central nervous system (CNS) infections, normally diagnosed by detection of VZV DNA in cerebrospinal fluid (CSF). Our aim was to investigate trends in VZV DNAemia in VZV CNS infections, which could potentially contribute to diagnosis and secondly, correlate the amount of VZV DNA in serum to severity of disease. Methods Seventy-two patients with VZV CNS infections diagnosed by detection of VZV DNA in CSF and concomitant neurological symptoms were included. The amount of VZV DNA was measured by real-time PCR in paired serum and CSF samples and compared to a control group of herpes zoster (n = 36). Results An increased amount of VZV DNA was detected in serum in patients with encephalitis compared to patients with meningitis or Ramsay-Hunt syndrome, respectively ( p  = 0.003 and p  = 0.024). A greater proportion of patients with VZV CNS infections and detectable VZV DNA in serum had ongoing rash compared to those without detectable VZV DNA in serum ( p  ≤ 0.001). The viral load in serum of patients with neurological symptoms was lower compared to in patients with herpes zoster without neurological symptoms ( p  ≤ 0.001) and only 32/72 of the patients with VZV CNS disease had VZV DNA detected in serum. Conclusion Increased amount of VZV DNA in serum of patients with VZV CNS infections seems associated with encephalitis and ongoing rash. Additionally, viral DNA analysis by PCR in serum may be a helpful diagnostic tool although viral DNA analysis by PCR in CSF is the method of choice for diagnosis.