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| __NOTOC__
| | #REDIRECT [[Varicella zoster encephalitis]] |
| {{CMG}} {{AE}} {{AG}}
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| {{SK}} Varicella zoster virus encephalitis; Herpes zoster encephalitis; Varicella zoster encephalitis; Varicella encephalitis;
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| ==Overview==
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| ==Classification==
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| Based on the duration of symptoms, VZV encephalitis may be classified into either acute or chronic.
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| ==Pathophysiology==
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| The exact pathogenesis of VZV encephalitis is not fully understood. It is known that VZV encephalitis is the result of the [[varicella zoster virus]], a double-stranded [[DNA virus]] within the [[Herpesviridae]] family of viruses.<ref name=Mandell1> M.D. JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Expert Consult Premium Edition. Saunders; 2014.</ref> The [[immune system]] eliminates the virus from most locations, but it remains [[viral latency|latent]] in the [[dorsal root ganglion]] and the [[trigeminal]] ganglion near the base of the skull. Initial infection by VZV presents as [[chickenpox]], often in children between 1-9. VZV reactivation, which presents as [[shingles]] in adults, is the result of a decline in the frequency of VZV-specific [[T cell]]s.<ref name="pmid9300702">{{cite journal| author=Sadzot-Delvaux C, Kinchington PR, Debrus S, Rentier B, Arvin AM| title=Recognition of the latency-associated immediate early protein IE63 of varicella-zoster virus by human memory T lymphocytes. | journal=J Immunol | year= 1997 | volume= 159 | issue= 6 | pages= 2802-6 | pmid=9300702 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9300702 }} </ref> The molecular basis of reactivation remains unknown.<ref name=Mandell1> M.D. JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Expert Consult Premium Edition. Saunders; 2014.</ref> Some histopathologic studies suggest of a postinfectious [[demyelinating]] process, while other findings cite direct viral cytopathology.<ref name="pmid6326714">{{cite journal| author=Bauman ML, Bergman I| title=Postvaricella encephalitis. | journal=Arch Neurol | year= 1984 | volume= 41 | issue= 5 | pages= 556-8 | pmid=6326714 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6326714 }} </ref><ref name="pmid4311227">{{cite journal| author=McCormick WF, Rodnitzky RL, Schochet SS, McKee AP| title=Varicella-Zoster encephalomyelitis. A morphologic and virologic study. | journal=Arch Neurol | year= 1969 | volume= 21 | issue= 6 | pages= 559-70 | pmid=4311227 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4311227 }} </ref><ref name="pmid582251">{{cite journal| author=Takashima S, Becker LE| title=Neuropathology of fatal varicella. | journal=Arch Pathol Lab Med | year= 1979 | volume= 103 | issue= 5 | pages= 209-13 | pmid=582251 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=582251 }} </ref>
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| ==Causes==
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| VZV encephalitis may be caused by either varicella ([[chickenpox]]) or herpes zoster ([[shingles]]).
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| ==Differentiating VZV Encephalitis from Other Diseases==
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| VZV encephalitis must be differentiated from other diseases that cause [[fever]], [[headache]], [[vomiting]], and [[altered mental status]], such as:<ref name="pmid14978145">{{cite journal| author=Kennedy PG| title=Viral encephalitis: causes, differential diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 1 | issue= | pages= i10-5 | pmid=14978145 | doi= | pmc=PMC1765650 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145 }} </ref><ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue= | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193 }} </ref><ref name="pmid13065322">{{cite journal| author=APPELBAUM E, RACHELSON MH, DOLGOPOL VB| title=Varicella encephalitis. | journal=Am J Med | year= 1953 | volume= 15 | issue= 2 | pages= 223-30 | pmid=13065322 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13065322 }} </ref>
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| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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| ! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
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| ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''Other [[Viral encephalitis]] '''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with acute [[inflammation]] of the [[brain]], caused by a [[viral infection]]; it may complicate into severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to [[mortality]]. {{see also|Herpes simplex encephalitis|West Nile encephalitis|St. Louis encephalitis|Japanese encephalitis}}
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Bacterial encephalitis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with acute [[inflammation]] of the [[brain]], caused by a [[bacterial infection]]; it may complicate into severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to [[mortality]]. {{see also|Tick-borne encephalitis}}
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Encephalopathy]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with steady [[depression]], generalized [[seizures]]. Generally absent are [[fever]], [[headache]], [[leukocytosis]], and [[pleocytosis]]; [[MRI]] often appears normal.
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningitis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |Presents with [[headache]], [[altered mental status]], and [[inflammation]] of the [[meninges]], which may develop in the setting of an [[infection]], physical injury, [[cancer]], or certain drugs; it may have an indolent evolution, resolving on its own, or may present as an rapidly evolving [[inflammation]], causing neurologic damage and possible [[mortality]]. {{see also|bacterial meningitis|viral meningitis|fungal meningitis}}
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| | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Brain abscess]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |Presents with an [[abscess]] in the [[brain]] caused by the [[inflammation]] and accumulation of [[infected]] material from local or remote infectious areas of the body; the infectious agent may also be introduced as a result of head [[trauma]] or [[neurosurgery|neurological procedures]].
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute disseminated encephalomyelitis]]'''
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| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with scattered foci of [[demyelination]] and perivenular [[inflammation]]; it can cause focal neurological signs and decreased ability to focus.
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| ==Epidemiology and Demographics==
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| ===Incidence===
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| The incidence of VZV encephalitis is approximately 10 per 100,000 individuals affected with [[varicella]].<ref name="pmid7658062">{{cite journal| author=Choo PW, Donahue JG, Manson JE, Platt R| title=The epidemiology of varicella and its complications. | journal=J Infect Dis | year= 1995 | volume= 172 | issue= 3 | pages= 706-12 | pmid=7658062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7658062 }} </ref>
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| ===Age===
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| VZV encephalitis most commonly affects infants or the elderly.<ref name="pmid7658062">{{cite journal| author=Choo PW, Donahue JG, Manson JE, Platt R| title=The epidemiology of varicella and its complications. | journal=J Infect Dis | year= 1995 | volume= 172 | issue= 3 | pages= 706-12 | pmid=7658062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7658062 }} </ref>
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| ===Gender===
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| Men and women are affected equally by VZV encephalitis.
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| ==Risk Factors==
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| Common risk factors in the development of VZV encephalitis include:<ref name="Mounsey">{{cite journal|title=Herpes zoster and postherpetic neuralgia: prevention and management|author=Mounsey AL, Matthew LG, & Slawson DC|date=2005|journal=American Family Physician|volume=72|issue=6|pages=1075-1080|pmid=16190505|url=http://www.aafp.org/afp/20050915/1075.html|accessdate=2007-06-15}}</ref><ref>{[cite journal|title=What does epidemiology tell us about risk factors for herpes zoster?|author=Thomas SL, Hall AJ|journal= Lancet Infect Dis.|date=2004|volume=4|issue=1|pages=26-33|pmid= 14720565}}</ref><ref name="pmid12353193">{{cite journal| author=Gnann JW| title=Varicella-zoster virus: atypical presentations and unusual complications. | journal=J Infect Dis | year= 2002 | volume= 186 Suppl 1 | issue= | pages= S91-8 | pmid=12353193 | doi=10.1086/342963 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12353193 }} </ref><ref name=IDSAEnceph> The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Encephalitis.pdf Accessed on February 16, 2016.</ref>
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| *[[Varicella zoster virus]] infection
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| *[[Immunosuppression]]
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| *[[HIV]] or [[AIDS]]]
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| *[[Age]] extremes
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| *[[Stress]]
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| *Long-term use of [[coritcosteriod]]s
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| *[[Skin]] [[inflammation]]
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| *[[Pregnancy]]
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| *Living in tropical climate
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| *Working as a [[physician]] or other [[health care provider]]
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| ==Natural History, Complications, and Prognosis==
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| ===Natural History===
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| If left untreated, [[immunocompromised]] patients with VZV encephalitis may progress to [[mortality]].
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| ===Complications===
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| Common complications of VZV encephalitis include:<ref name="pmid14978145">{{cite journal| author=Kennedy PG| title=Viral encephalitis: causes, differential diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 1 | issue= | pages= i10-5 | pmid=14978145 | doi= | pmc=PMC1765650 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145 }} </ref>
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| *[[Shock]]
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| *[[Hypoxemia]]
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| *[[Hypotension]]
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| *[[Aphasia]]
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| *[[Seizures]]
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| *[[Meningitis]]
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| *Loss of [[motor]] skills
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| *[[Coma]]
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| *[[Mortality]]
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| ===Prognosis===
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| Prognosis for VZV encephalitis is poor in [[immunocompromised]] individuals.
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| ==Diagnosis==
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| ===History and Symptoms===
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| ===Physical Examination===
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| ===Laboratory Findings===
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| ===CT===
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| ===MRI===
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| ==Treatment==
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| ===Medical Therapy===
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| ===Prevention===
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| ==References==
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| {{reflist|2}}
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| [[Category:Primary care]]
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| [[Category:Viral diseases]]
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| [[Category:Infectious disease]]
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| [[Category:Neurology]]
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