Lewandowski Dawid, Toczylowski Kacper, Kowalska Malgorzata, Krasnodębska Milena, Krupienko Iryna, Nartowicz Karolina, Sulik Magdalena, Sulik Artur
Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
Department of Pediatric Surgery and Neurology, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
Vaccines (Basel). 2024 Sep 23;12(9):1086. doi: 10.3390/vaccines12091086.
Varicella-Zoster Virus (VZV) is characterized by its ability to enter a dormant state within the body. When the wild or vaccine virus reactivates, it can lead to herpes zoster (HZ), which infrequently manifests as a neuroinfection.
The aim of the study was to analyze the clinical manifestations and outcomes associated with VZV reactivation in the CNS in immunocompetent children.
We searched medical databases for case reports using the keywords "zoster", "meningitis", "encephalitis", and "immunocompetent". The inclusion criteria were age below 18 years, any gender, race, and ethnicity, no features or history of immunodeficiency, and confirmation of VZV reactivation through the detection of VZV DNA in the CSF. Patients were categorized into two groups: children experiencing the reactivation of the wild virus and children with the vaccine strain virus.
The cohort included six children hospitalized in our hospital and 49 children reported in the literature. In 37 (67%), a wild-type virus was detected, while in 18 (33%), an infection was caused by the vaccine strain. There were no differences in the clinical presentation between the two groups. A typical rash was observed in 32 (58%) children. Approximately 41 of the 55 children (75%) received antiviral treatment. Four patients experienced complications.
Neither a history of VZV immunization nor the absence of a skin rash can definitively exclude VZV meningitis. It is important to note that any seemingly healthy child, regardless of recognized risk factors, could develop HZ meningitis.
水痘带状疱疹病毒（VZV）的特点是能够在体内进入休眠状态。当野生型或疫苗病毒重新激活时，可导致带状疱疹（HZ），其很少表现为神经感染。
本研究旨在分析免疫功能正常儿童中枢神经系统中VZV重新激活相关的临床表现及转归。
我们使用关键词“带状疱疹”“脑膜炎”“脑炎”和“免疫功能正常”在医学数据库中检索病例报告。纳入标准为年龄低于18岁、任何性别、种族和族裔、无免疫缺陷特征或病史，以及通过脑脊液中检测到VZV DNA证实VZV重新激活。患者分为两组：野生病毒重新激活的儿童和疫苗株病毒感染的儿童。
队列包括我院住院的6名儿童和文献报道的49名儿童。37例（67%）检测到野生型病毒，18例（33%）感染由疫苗株引起。两组临床表现无差异。32例（58%）儿童观察到典型皮疹。55例儿童中约41例（75%）接受了抗病毒治疗。4例患者出现并发症。
VZV免疫史或无皮疹均不能明确排除VZV脑膜炎。需要注意的是，任何看似健康的儿童，无论是否存在公认的危险因素，都可能发生HZ脑膜炎。
