Varicella-Zoster Virus Infections

Area of Science:

• Neurology
• Virology
• Infectious Diseases

Background:

• Varicella-zoster virus (VZV) reactivation can lead to a wide spectrum of neurologic complications.
• These complications may manifest without the characteristic rash, posing diagnostic challenges.

Purpose of the Study:

• To describe the clinical, laboratory, and imaging features of VZV-induced neurologic disorders.
• To highlight diagnostic strategies for VZV infections of the nervous system, even in the absence of rash.
• To outline optimal treatment approaches for VZV reactivation.

Main Methods:

• Review of clinical features, laboratory findings, and imaging abnormalities associated with VZV reactivation.
• Discussion of diagnostic confirmation using cerebrospinal fluid (CSF) analysis for VZV DNA or antibodies.
• Inclusion of recent evidence implicating VZV in giant cell arteritis.

Main Results:

• VZV reactivation can cause various central and peripheral nervous system disorders, including zoster, postherpetic neuralgia, meningoencephalitis, cranial nerve palsies, myelopathy, and vasculopathy.
• Neurologic manifestations of VZV can occur without a rash.
• Diagnosis is confirmed by detecting VZV DNA or antibodies in CSF.

Conclusions:

• Clinicians must recognize that VZV reactivation can cause diverse neurologic conditions, often without a rash.
• Early virologic confirmation and prompt antiviral therapy are essential for favorable outcomes.
• Complete recovery is achievable even in severe or prolonged VZV-related neurologic diseases.