TY - JOUR
T1 - The value of cerebrospinal fluid antiviral antibody in the diagnosis of neurologic disease produced by varicella zoster virus
AU - Gilden, D. H.
AU - Bennett, J. L.
AU - Kleinschmidt-Demasters, B. K.
AU - Song, D. D.
AU - Yee, A. S.
AU - Steiner, I.
N1 - Funding Information:
Our third patient had AIDS complicated by acute encephalitis. His brain imaging showed abnormalities typical of the vasculopathy of VZV encephalitis [1, 7] . This was supported by the detection of antibody to VZV in CSF, and confirmed by the presence of both antibody to VZV and VZV DNA in the CSF four days later. The coexisting high titer of antibody to CMV was initially confounding, particularly since CMV reactivates frequently in AIDS patients. However, the presence on brain imaging of lesions at gray-white matter junctions typical for the vasculopathy of VZV encephalitis [1, 7] , the demonstration of both VZV DNA and VZV-specific antibody in CSF, and the rapid favorable response of our patient's encephalitis to acyclovir (CMV infection is not as likely to respond to acyclovir as to ganciclovir), combined to indict VZV as the cause of his virus encephalitis.
PY - 1998/8/14
Y1 - 1998/8/14
N2 - We studied four patients with subacute to chronic varicella zoster virus (VZV) infection of the central nervous system (CNS). VZV infection was verified by detecting antibody to VZV in the cerebrospinal fluid (CSF). VZV caused myelitis in two patients and encephalitis in two patients. In one of the patients with VZV encephalitis, in addition to VZV IgM antibody, VZV DNA was found in the CSF. Among the four patients with VZV infection of the CNS, CSF antibody to VZV was the crucial diagnostic laboratory test which corroborated the clinical features, and indicated that VZV caused neurologic disease. In addition to looking for amplifiable VZV DNA in the CSF of patients with neurologic disease whose clinical and radiologic features suggest VZV infection, we also recommend a search for CSF antibody to VZV, particularly in patients with intervals of weeks to months between zoster and the onset of neurologic disease, or in those patients without rash in whom the tempo of illness is unknown.
AB - We studied four patients with subacute to chronic varicella zoster virus (VZV) infection of the central nervous system (CNS). VZV infection was verified by detecting antibody to VZV in the cerebrospinal fluid (CSF). VZV caused myelitis in two patients and encephalitis in two patients. In one of the patients with VZV encephalitis, in addition to VZV IgM antibody, VZV DNA was found in the CSF. Among the four patients with VZV infection of the CNS, CSF antibody to VZV was the crucial diagnostic laboratory test which corroborated the clinical features, and indicated that VZV caused neurologic disease. In addition to looking for amplifiable VZV DNA in the CSF of patients with neurologic disease whose clinical and radiologic features suggest VZV infection, we also recommend a search for CSF antibody to VZV, particularly in patients with intervals of weeks to months between zoster and the onset of neurologic disease, or in those patients without rash in whom the tempo of illness is unknown.
KW - Antibody
KW - CSF
KW - Myelitis
KW - PCR
KW - VZV encephalitis
UR - http://www.scopus.com/inward/record.url?scp=0032516928&partnerID=8YFLogxK
U2 - 10.1016/S0022-510X(98)00153-1
DO - 10.1016/S0022-510X(98)00153-1
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C2 - 9741397
AN - SCOPUS:0032516928
SN - 0022-510X
VL - 159
SP - 140
EP - 144
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
IS - 2
ER -