Kushawaha Anurag, Mobarakai Neville, Tolia Jill
Department of Medicine, Division of Infectious Diseases, Island University Hospital 475 Seaview Ave., Staten Island, NY 10305 USA.
Cases J. 2009 Sep 1;2:6299. doi: 10.4076/1757-1626-2-6299.
Varicella zoster virus causes two distinct clinical diseases. Varicella is the primary infection and results from exposure of a person susceptible to the virus. The virus remains latent in cranial nerve ganglia, dorsal root ganglia, and autonomic ganglia along the entire neuraxis. Years later, in association with a decline in cell-mediated immunity in the elderly and immuno-compromised, varicella zoster virus reactivates and can cause a wide range of neurologic disease, including herpes zoster ('shingles'), postherpetic neuralgia, vasculopathy, myelopathy, retinal necrosis, cerebellitis, and zoster sine herpete. Herpes zoster is associated with numerous neurologic complications and varied presentations. Patients who have a dermatomal distribution of varicella zoster virus and who have headaches should be considered to have VZV meningitis. Virologic confirmation requires testing the cerebrospinal fluid for varicella zoster virus deoxyribonucleic acid via polymerase chain reaction. The application of polymerase chain reaction to the cerebrospinal fluid can be used to detect varicella zoster virus deoxyribonucleic acid and, therefore, infections of the central nervous system. We present a case report of a 46-year-old female who initially presented with worsening headache, nuchal rigidity, fever, and a skin rash, who was subsequently found to have varicella zoster meningitis.
水痘带状疱疹病毒可引发两种截然不同的临床疾病。水痘是原发性感染，由易感人群接触该病毒所致。病毒会潜伏在沿整个神经轴的颅神经节、背根神经节和自主神经节中。数年后，随着老年人和免疫功能低下者细胞介导免疫功能的下降，水痘带状疱疹病毒会重新激活，并可引发多种神经系统疾病，包括带状疱疹（“缠腰龙”）、带状疱疹后神经痛、血管病变、脊髓病、视网膜坏死、小脑炎以及无疹性带状疱疹。带状疱疹与众多神经系统并发症及多样的临床表现相关。水痘带状疱疹病毒呈皮节分布且伴有头痛的患者应被考虑患有水痘带状疱疹病毒脑膜炎。病毒学确诊需要通过聚合酶链反应检测脑脊液中的水痘带状疱疹病毒脱氧核糖核酸。将聚合酶链反应应用于脑脊液可用于检测水痘带状疱疹病毒脱氧核糖核酸，进而检测中枢神经系统感染。我们报告一例46岁女性病例，该患者最初表现为头痛加重、颈项强直、发热及皮疹，随后被诊断为水痘带状疱疹病毒脑膜炎。
