ORIGINAL PAPER
Encephalitis, meningitis, and acute cerebellar ataxia as neurological complications of VZV infection in children. A retrospective study
1
Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
2
Pediatric Radiology, Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
Submission date: 2021-12-11
Acceptance date: 2022-01-24
Publication date: 2022-03-23
Pediatr Pol 2022;97(1):20-28
KEYWORDS
TOPICS
ABSTRACT
Aim of the study:
Varicella is a disease with potentially severe complications. The objective of this study was to assess the specific clinical picture of neurological complications of VZV in the form of encephalitis, meningitis, and acute cerebellar ataxia among hospitalised children.
Material and methods:
The study was designed as a retrospective analysis, based on reviewing the medical records and collecting post-hospitalisation questionnaires of children admitted to the hospital for varicella complications between January 2009 and December 2018. None of the patients was vaccinated. Patients were divided into groups based on the type of neurological diagnosis. We analysed the results of the additional tests performed, their significance for the final diagnosis, and predictive validity. Statistical analysis of data was performed, and the results were compared with available data.
Results:
A link between age and type of neurological complication was found. Diversity in the length of hospitalisation as well as in the number of additional tests necessary for a final diagnosis was established. None of the analysed clinical parameters and additional tests was found to be a potential predictor linked with the possibility of sequels in our study. Children with encephalitis had a significantly higher risk of neurological sequelae at the moment of discharge.
Conclusions:
Acute cerebellar ataxia was the most frequent neurological complication, while encephalitis was associated with increased risk of neurological sequel. Direct presence of VZV-DNA was observed in patients with meningitis, while acute cerebellar ataxia and encephalitis were a result of an immune response. The presented results serve as a reminder of the potential severity of chickenpox in unvaccinated, otherwise immunocompetent children.
Varicella is a disease with potentially severe complications. The objective of this study was to assess the specific clinical picture of neurological complications of VZV in the form of encephalitis, meningitis, and acute cerebellar ataxia among hospitalised children.
Material and methods:
The study was designed as a retrospective analysis, based on reviewing the medical records and collecting post-hospitalisation questionnaires of children admitted to the hospital for varicella complications between January 2009 and December 2018. None of the patients was vaccinated. Patients were divided into groups based on the type of neurological diagnosis. We analysed the results of the additional tests performed, their significance for the final diagnosis, and predictive validity. Statistical analysis of data was performed, and the results were compared with available data.
Results:
A link between age and type of neurological complication was found. Diversity in the length of hospitalisation as well as in the number of additional tests necessary for a final diagnosis was established. None of the analysed clinical parameters and additional tests was found to be a potential predictor linked with the possibility of sequels in our study. Children with encephalitis had a significantly higher risk of neurological sequelae at the moment of discharge.
Conclusions:
Acute cerebellar ataxia was the most frequent neurological complication, while encephalitis was associated with increased risk of neurological sequel. Direct presence of VZV-DNA was observed in patients with meningitis, while acute cerebellar ataxia and encephalitis were a result of an immune response. The presented results serve as a reminder of the potential severity of chickenpox in unvaccinated, otherwise immunocompetent children.
REFERENCES (26)
1.
Persson A, Bergstrom T, Lindh M, et al. Varicella-zoster virus CNS disease – viral load, clinical manifestations and sequels. J Clin Virol 2009; 46: 249-253.
2.
De Broucker T, Mailles A, Chabrier S, et al. Acute varicella zoster encephalitis without evidence of primary vasculopathy in a case- series of 20 patients. Clin Microbiol Infect 2012; 18: 808-819.
3.
Rack AL, Grote V, Streng A, et al. Neurologic varicella complications before routine immunisation in Germany. Pediatr Neurol 2010; 42: 40-48.
4.
Bozzola E, Tozzi AE, Bozzola M, et al. Neurological complications of varicella in childhood: case series and a systematic review of the literature. Vaccine 2012; 30: 5785-5790.
5.
Cameron JC, Allan G, Johnston F, et al. Severe complications of chickenpox in hospitalised children in the UK and Ireland. Arch Dis Child 2007; 92: 1062-1066.
6.
Koturoglu G, Kurugöl Z, Cetin N, et al. Complications of varicella in healthy children in Izmir. Turkey Pediatr Int 2005; 47: 296-299.
7.
Frenos S, Galli L, Chiappini E, de Martino M. An increasing incidence of chickenpox central nervous system complications in children: what’s happening in Tuscany? J Clin Virol 2007; 38: 358-361.
8.
Bozzola E, Bozzola M, Tozzi AE, et al. Acute cerebellitis in varicella: a ten year case series and systematic review of the literature. Ital J Pediatr 2014; 40: 57.
9.
Koskiniemi M, Piiparinen H, Rantalaiho T, et al. Acute central nervous system complications in varicella zoster virus infections. J Clin Virol 2002; 25: 293-301.
10.
Miller ER, Kelly HA. Varicella infection – evidence for peak activity in summer months. J Infect 2008; 56: 360-365.
11.
Mészner Z, Wysocki J, Richter D, et al. Burden of varicella in Central and Eastern Europe: findings from a systematic literature review. Expert Rev Vaccines 2019; 18: 281-293.
12.
Helmuth IG, Poulsen A, Suppli CH, Mølbak K. Varicella in Europe – a review of the epidemiology and experience with vaccination. Vaccine 2015; 33: 2406-2413.
13.
Grimprel E, Levy C, de La Rocque F, et al. Paediatric varicella hospitalisations in France: a nationwide survey. Clin Microbiol Infect 2007; 13: 546-549.
14.
Blumental S, Sabbe M, Lepage P. Varicella paediatric hospitalisations in Belgium: a 1-year national survey. Arch Dis Child 2016; 101: 16-22.
15.
Liese JG, Grote V, Rosenfeld E, et al.; ESPED Varicella Study Group. The burden of varicella complications before the introduction of routine varicella vaccination in Germany. Pediatr Infect Dis J 2008; 27: 119-124.
16.
Guess HA, Broughton DD, Melton LJ 3rd, Kurland LT. Population- based studies of varicella complications. Pediatrics 1986; 78: 723-727.
17.
Vial C, Pozzetto B, Essid A, et al. Acute encephalitis: report on 32 consecutive pediatric cases observed in one hospital. Medecine et Maladies Infectieuses 2007; 37: 208-214.
18.
Bonhoeffer J, Baer G, Muehleisen B, et al. Prospective surveillance of hospitalisations associated with varicella-zoster virus infections in children and adolescents. Eur J Pediatr 2005; 164: 366-370.
19.
Aberle SW, Aberle JH, Steininger C, Puchhammer-Stöckl E. Quantitative real time PCR detection of Varicella-zoster virus DNA in cerebrospinal fluid in patients with neurological disease. Med Microbiol Immunol 2005; 19: 7-12.
20.
Becerra JC, Sieber R, Martinetti G, et al. Infection of the central nervous system caused by varicella zoster virus reactivation: a retrospective case series study. Int J Infect Dis 2013; 17: e529-e534.
21.
Whitley RJ. Varicella-zoster virus. In: Mandell GL, Bennett JE, Dolin R (eds.). Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 7th ed. Churchill Livingstone Elsevier, Philadelphia 2009; 1963-1969.
22.
Lancella L, Esposito S, Galli ML, et al. Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy. Ital J Pediatr 2017; 43: 54.
23.
Steiner I, Budka H, Chaudhuri A, et al. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2010; 17: 999-e57.
24.
Wang IJ, Lee PI, Huang LM, et al. The correlation between neurological evaluations and neurological outcome in acute encephalitis: a hospital-based study. Eur J Paediatr Neurol 2007; 11: 63-69.
25.
Dubos F, Grandbastien B, Hue V; Hospital Network for Evaluating Management of Common Childhood Diseases. Epidemiology of hospital admissions for paediatric varicella infections: a one-year prospective survey in the pre-vaccine era. Epidemiol Infect 2007; 135: 131-138.
Share
RELATED ARTICLE
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
