Rinsho Shinkeigaku (Clinical Neurology)

Original Article

Clinical, epidemiological and etiological studies of adult aseptic meningitis:
Report of 11 cases with varicella zoster virus meningitis

Shinichi Takeshima, M.D.1)2), Yuji Shiga, M.D.1), Takahiro Himeno, M.D.1), Keisuke Tachiyama, M.D.1)3), Teppei Kamimura, M.D.1)4), Ryuhei Kono, M.D.1), Makoto Takemaru, M.D.1), Jun Takeshita, M.D.1), Yutaka Shimoe, M.D., Ph.D.1) and Masaru Kuriyama, M.D., Ph.D.1)

1)Department of Neurology, Brain Attack Center, Ota Memorial Hospital
2)Present address: Department of Rehabilitation Medicine, Showa University School of Medicine
3)Present address: Hiroshima City Hiroshima Citizens Hospital
4)Present address: National Central and Cardiovascular Center

We treated 11 cases (52.7 ± 14.9 years, all male) with varicella zoster virus (VZV) meningitis and 437 cases with adult aseptic meningitis from 2004 to 2016. The incidence rate of adult VZV meningitis in the cases with aseptic meningitis was 2.5%. Herpes zoster infections are reported to have occurred frequently in summer and autumn. VZV meningitis also occurred frequently in the similar seasons, in our patients. The diagnoses were confirmed in 9 cases with positive VZV-DNA in the cerebrospinal fluid and in 2 cases with high VZV-IgG indexes (> 2.0). For diagnosis confirmation, the former test was useful for cases within a week of disease onset, and the latter index was useful for cases after a week of disease onset. Zoster preceded the meningitis in 8 cases, while the meningitis preceded zoster in 1 case, and 2 cases did not have zoster (zoster sine herpete). Two patients were carriers of the hepatitis B virus, 1 patient was administered an influenza vaccine 4 days before the onset of meningitis, and 1 patient was orally administered prednisolone for 2 years, for treatment. Their immunological activities might have been suppressed. The neurological complications included trigeminal neuralgia, facial palsy (Ramsay Hunt syndrome), glossopharyngeal neuralgia, and Elsberg syndrome. Because the diseases in some patients can become severe, they require careful treatment.
Full Text of this Article in Japanese PDF (602K)

(CLINICA NEUROL, 57: 492|498, 2017)
key words: adult aseptic meningitis, VZV-virus, VZV-DNA, VZV-IgG index, complication

(Received: 11-May-17)