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Varicella-zoster Virus pp 243–253Cite as

Neurological Disease Produced by Varicella Zoster Virus Reactivation Without Rash

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Part of the book series: Current Topics in Microbiology and Immunology ((CT MICROBIOLOGY,volume 342))

Abstract

Reactivation of varicella zoster virus (VZV) from latently infected human ganglia usually produces herpes zoster (shingles), characterized by dermatomal distribution pain and rash. Zoster is often followed by chronic pain (postherpetic neuralgia or PHN) as well as meningitis or meningoencephalitis, cerebellitis, isolated cranial nerve palsies that produce ophthalmoplegia or the Ramsay Hunt syndrome, multiple cranial nerve palsies (polyneuritis cranialis), vasculopathy, myelopathy, and various inflammatory disorders of the eye. Importantly, VZV reactivation can produce chronic radicular pain without rash (zoster sine herpete), as well as all the neurological disorders listed above without rash. The protean neurological and ocular disorders produced by VZV in the absence of rash are a challenge to the practicing clinician. The presentation of these conditions varies from acute to subacute to chronic. Virological confirmation requires the demonstration of amplifiable VZV DNA in cerebrospinal fluid (CSF) or in blood mononuclear cells, or the presence of anti-VZV IgG antibody in CSF or of anti-VZV IgM antibody in CSF or serum.

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Abbreviations

AIDS:

Acquired immune deficiency syndrome

CSF:

Cerebrospinal fluid

CT:

Computerized tomography

HSV:

Herpes simplex virus

Ig:

Immunoglobulin

MNCs:

Mononuclear cells

MRI:

Magnetic resonance imaging

PORN:

Progressive outer retinal necrosis

RHS:

Ramsay Hunt syndrome

SSPE:

Subacute sclerosing panencephalitis

VZV:

Varicella zoster virus

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Acknowledgements

This work was supported in part by Public Health Service grants AG006127, NS032623 and AG032958 from the National Institutes of Health. Maria Nagel is supported by Public Health Service grant NS007321 from the National Institutes of Health. The authors thank Marina Hoffman for editorial review and Cathy Allen for manuscript preparation.

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Authors and Affiliations

  1. Departments of Neurology (D.G., R.J.C., R.M., M.A.N.) and Microbiology (D.G.), University of Colorado Denver School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA

    Don Gilden, Randall J. Cohrs, Ravi Mahalingam & Maria A. Nagel

Authors
  1. Don Gilden
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  2. Randall J. Cohrs
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  3. Ravi Mahalingam
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  4. Maria A. Nagel
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Corresponding author

Correspondence to Don Gilden .

Editor information

Editors and Affiliations

  1. Department of Infectious Diseases and Im, Head, VZV Research Laboratory, University of Sydney, Room 601 Blackburn Building D06, Sydney, 2006, New South Wales, Australia

    Allison Abendroth

  2. School of Medicine, Dept. Microbiology & Immunology, Stanford University, Pasteur Drive 300, Stanford, 94305-5124, California, USA

    Ann M. Arvin

  3. 2215 Weiskotten Hall, Upstate Medical University, East Adams Street 750, Syracuse, 13210, New York, USA

    Jennifer F. Moffat

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Gilden, D., Cohrs, R.J., Mahalingam, R., Nagel, M.A. (2010). Neurological Disease Produced by Varicella Zoster Virus Reactivation Without Rash. In: Abendroth, A., Arvin, A., Moffat, J. (eds) Varicella-zoster Virus. Current Topics in Microbiology and Immunology, vol 342. Springer, Berlin, Heidelberg. https://doi.org/10.1007/82_2009_3

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