Varicella-zoster virus (VZV) causes a diverse spectrum of neurologic complications: aseptic meningitis, encephalitis, cerebral infarction associated with granulomatous vasculitis, myelitis, and cranial polyneuropathy. These VZV-associated central nervous system (CNS) diseases usually result from reactivation of latent infection in immunosuppressive conditions, such as old age, diabetes mellitus, cancer, human immunodeficiency virus (HIV) infection, and the use of immunosuppressive drugs. However, they also occur in immunocompetent subjects. Since VZV antigen or DNA is often detected in the cerebrospinal fluid of these patients, it is thought that reactivated VZV reaches the central nervous system by direct spread from latently infected sensory ganglia. Analysis of cerebrospinal fluid by PCR is important for the diagnosis of VZV-associated CNS diseases particularly in the absence of exanthema/herpes zoster. Clinicians should be aware of the neurologic complications of VZV infection, because early acyclovir therapy is necessary for these disorders.
Part of the book: Human Herpesvirus Infection