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Varicella-Zoster Encephalomyelitis: A Morphologic and Virologic Study

Varicella-Zoster Encephalomyelitis: A Morphologic and Virologic Study Abstract VARICELLA-ZOSTER (V-Z) encephalomyelitis is relatively uncommon. Detailed morphologic and virologic studies on such cases are extremely few. Our recent studies of two patients on whom complete autopsies were done, form the basis of this study. In one of these patients V-Z virus was cultured from the brain. Electron microscopic demonstration of virus particles in the brain was obtained on both cases. We believe this to be the first reported isolation of the V-Z virus and the first electron microscopic demonstration of the virus in human brain. Type A intranuclear inclusion bodies were seen in the brain and spinal cord of both patients. We are aware of no recorded observations of type A inclusions in the central nervous system (CNS) in patients with clinical herpes zoster and only one such report in a case of disseminated varicella. The literature, insofar as it is pertinent, is reviewed and a synthesis References 1. Lennette, E.H., and Schmidt, N.J. (eds.): Diagnostic Procedures for Viral and Rickettsial Diseases , ed 3, New York: American Public Health Assoc., Inc., 1964, pp 120-121. 2. von Bokay, J.: Über den Ätiologischen Zusammenhang der Varizellen Mit Gewissen Fällen Von Herpes Zoster , Wien Klin Wschr 22:1323-1326, 1909. 3. Weller, T.H., and Coons, A.H.: Fluorescent Antibody Studies With Agents of Varicella and Herpes Zoster Propagated in Vitro , Proc Soc Exp Biol Med 86:789-794 ( (Aug-Sept) ) 1954.Crossref 4. Weller, T.H.; Witton, H.M.; and Bell, E.J.: Etiologic Agents of Varicella and Herpes Zoster , J Exp Med 108:843-868 ( (Dec) ) 1958.Crossref 5. Hope-Simpson, R.E.: The Nature of Herpes Zoster: A Long Term Study and a New Hypothesis , Proc Roy Soc Med 58:9-12 ( (Jan) ) 1965. 6. Downie, A.W.: Chickenpox and Zoster , Brit Med Bull 15:197-200 ( (Sept) ) 1959. 7. Robbins, S.L.: Pathology , ed 3, Philadelphia: W. B. Saunders Co., 1967, p 359. 8. Rhodes, A.J., and VanRooyen, C.E.: Textbook of Virology , ed 5, Baltimore: Williams & Wilkins Co, 1968, p 402. 9. Merselis, J.G.; Kaye, D.; and Hook, E.W.: Disseminated Herpes Zoster , Arch Intern Med 113:679-686 ( (May) ) 1964.Crossref 10. Bright, R.: Reports of Medical Cases , London: Longmans, Ltd., 1831, vol 2, pt 1, p 383. 11. von Bärensprung, F.G.F.: Beiträge zur Kenntnis des Zoster , Ann Charité-Krankenh 11:96-104 ( (No. 2) ) 1863. 12. Head, H., and Campbell, A.W.: The Pathology of Herpes Zoster and Its Bearing on Sensory Localization , Brain 23:23-519 ( (pt 3) ) 1900.Crossref 13. Lhermitte, J., and Nicolas, M.: Les lesions spinales du zona; la myélite zostérienne , Rev Neurol 1:361-364 ( (Feb 28) ) 1924. 14. Thalhimer, W.: Herpes Zoster: Central Nervous System Lesions Similar to Those of Epidemic (Lethargic) Encephalitis , Arch Neurol Psychiat 12:73-79 ( (July) ) 1924.Crossref 15. Denny-Brown, D.; Adams, R.D.; and Fitzgerald, P.J.: Pathologic Features of Herpes Zoster , Arch Neurol Psychiat 51:216-231 ( (March) ) 1944.Crossref 16. Lander, H.: A Case of Acute Haemorrhagic Leucoencephalitis (Hurst) Complicating Varicella , J Path Bact 70:157-165 ( (July) ) 1955.Crossref 17. Nicolaides, N.V.: Fatal Systemic Varicella: A Report of Three Cases , Med J Aust 2:88-91 ( (July 20) ) 1957. 18. Miller, H.G.; Stanton, J.B.; and Gibbon, J.L.: Para-Infectious Encephalomyelitis and Related Syndromes , Quart J Med 25:427-505 ( (Oct) ) 1956. 19. Rotem, C.: Complications of Chicken Pox , Brit Med J 1:944-947 ( (April 1) ) 1961.Crossref 20. Athanassiades, T., and Nicolopoulos, D.: Complications of Varicella , Lancet 2:403 ( (Aug 17) ) 1968.Crossref 21. Rinvik, R.: Congenital Varicella Encephalomyelitis in Surviving Newborn , Amer J Dis Child 117:231-235 ( (Feb) ) 1969. 22. Hassin, G.B., and Rabens, I.A.: Herpetic Meningoencephalitis , J Neuropath Exp Neurol 3:355-367 ( (Oct) ) 1944.Crossref 23. Boudin, G., et al: L'encéphalo-myélite zostérienne , Rev Neurol 99:535-537 ( (Nov) ) 1958. 24. Appelbaum, G.; Kreps, S.I.; and Sunshine, A.: Herpes Zoster Encephalitis , Amer J Med 32:25-31 ( (Jan) ) 1962.Crossref 25. Rose, F.C.; Brett, E.M.; and Burston, J.: Zoster Encephalomyelitis , Arch Neurol 11:155-172 ( (Aug) ) 1964.Crossref 26. Dunn, M., and Salter, R.H.: Zoster Encephalitis , Brit J Clin Pract 22:444-445 ( (Oct) ) 1968. 27. Tako, J., and Rado, J.P.: Zoster Meningoencephalitis in a Steroid-Treated Patient , Arch Neurol 12:610-612 ( (June) ) 1965.Crossref 28. Perier, O., et al: Etude Clinique et Anatomique de Deux Cas d'Encéphalite Zostérienne , Acta Neurol Belg 66:53-73, 1966. 29. Schirmer, A., and Regli, F.: Neurologische Komplikationen bei Herpes Zoster , Schweiz Med Wschr 97:731-735 ( (No. 23) ) 1967. 30. Haymaker, W., et al: " Pathology of Viral Disease in Man Characterized by Nuclear Inclusions ," in Fields, W.S., and Blattner (eds.): Viral Encephalitis , Springfield, Ill: Charles C Thomas, Publisher, 1958. 31. Gold, E.: Serologic and Virus Isolation Studies of Patients With Varicella or Herpes Zoster Infection , New Eng J Med 274:181-185 ( (Jan 27) ) 1966.Crossref 32. Cheatham, W.J., et al: Varicella: Report of Two Fatal Cases With Necropsy, Virus Isolation and Serologic Studies , Amer J Path 32:1015-1035 ( (Sept-Oct) ) 1956. 33. Muller, S.A.: Association of Zoster and Malignant Disorders in Children , Arch Derm 96:657-663 ( (Dec) ) 1967.Crossref 34. Ranney, E.K.; Norman, M.G.; and Silver, M.D.: Varicella Pneumonitis , Canad Med Assoc J 96:445-450 ( (Feb 25) ) 1967. 35. Keidan, S.E., and Mainwaring, D.: Association of Herpes Zoster With Leukemia and Lymphoma in Children , Clin Pediat 4:13-17 ( (Jan) ) 1965.Crossref 36. Sokal, V.E., and Firat, D.: Varicella-Zoster Infection in Hodgkin's Disease , Amer J Med 39:452-463 ( (Sept) ) 1965.Crossref 37. Casazza, A.R.; Duvall, C.P.; and Carbone, P.P.: Infection in Lymphoma , JAMA 197:710-716 ( (Aug 29) ) 1966.Crossref 38. Koehler, H.: Zur Pathogenese des Herpes zoster bei Systemerkrankngen, insbesondere bei Mykosis Fungoides , Der Hautarzt 19:16-20 ( (Jan) ) 1968. 39. Rifkind, D.: The Activation of Varicella-Zoster Virus Infection by Immunosuppressive Therapy , J Lab Clin Med 68:463-474 ( (Sept) ) 1966. 40. Ultmann, J.E., et al: The Clinical Implications of Hypogammaglobulinemia in Patients With Chronic Lymphocytic Leukemia and Lymphosarcoma , Ann Intern Med 51:501-516 ( (Sept) ) 1959.Crossref 41. Elliot, F.A.: Shingles , Lancet 2:170-171 ( (July 20) ) 1968.Crossref 42. Sabin, A.B., and Koch, M.A.: Behavior of Non-infectious SV40 Viral Genome in Hamster Tumor Cells: Induction of Synthesis of Infectious Virus , Proc Nat Acad Sci 50:407-417 ( (Sept 15) ) 1963.Crossref 43. Hook, E.B., et al: Familial Fatal Varicella , JAMA 206:305-311 ( (Oct 7) ) 1968.Crossref 44. Suzuki, Y.: Neurological Complications of Varicella , Adv Neurol Sci 11:887-896 ( (Dec) ) 1967. 45. Lutzner, M.A.: Fine Structure of the Zoster Virus in Human Skin , J Ultrastruct Res 7:409-417 ( (Dec) ) 1962.Crossref 46. Tournier, P.; Cathala, F.; and Bernhard, W.: Ultrastructure et Développment Intracellulaire du Virus de la Varicelle Observé en Microscope Electronique , Presse Med 65:1229-1234 ( (June 29) ) 1957. 47. Kaplan, A.S.: Herpes Simplex and Pseudorabies Viruses , New York: Springer-Verlag, 1969. 48. McKee, A.P., et al: Herpes Simplex Encephalitis , Southern Med J 61:217-225 ( (March) ) 1968.Crossref 49. Swanson, J.L.; Craighead, J.E.; and Reynolds, E.S.: Electron Microscopic Observations on Herpesvirus hominis (Herpes Simplex Virus) Encephalitis in Man , Lab Invest 15:1966-1981 ( (Dec) ) 1966. 50. Bennett, D.R.; ZuRhein, G.M.; and Roberts, T.S.: Acute Necrotizing Encephalitis , Arch Neurol 6:96-113 ( (Feb) ) 1962.Crossref 51. Adams, J.H., and Jennett, W.B.: Acute Necrotizing Encephalitis: A Problem in Diagnosis , J Neurol Neurosurg Psychiat 30:248-260 ( (April) ) 1967.Crossref 52. Johnson, R.T.; Olson, L.C.; and Buescher, E.L.: Herpes Simplex Virus Infections of the Nervous System , Arch Neurol 18:260-264 ( (March) ) 1968.Crossref 53. Lynfield, Y.L.; Farhangi, M.; and Runnels, J.L.: Generalized Herpes Simplex Complicating Lymphoma , JAMA 207:944-945 ( (Feb 3) ) 1969.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Varicella-Zoster Encephalomyelitis: A Morphologic and Virologic Study

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American Medical Association
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Copyright © 1969 American Medical Association. All Rights Reserved.
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0003-9942
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1538-3687
DOI
10.1001/archneur.1969.00480180015001
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Abstract

Abstract VARICELLA-ZOSTER (V-Z) encephalomyelitis is relatively uncommon. Detailed morphologic and virologic studies on such cases are extremely few. Our recent studies of two patients on whom complete autopsies were done, form the basis of this study. In one of these patients V-Z virus was cultured from the brain. Electron microscopic demonstration of virus particles in the brain was obtained on both cases. We believe this to be the first reported isolation of the V-Z virus and the first electron microscopic demonstration of the virus in human brain. Type A intranuclear inclusion bodies were seen in the brain and spinal cord of both patients. We are aware of no recorded observations of type A inclusions in the central nervous system (CNS) in patients with clinical herpes zoster and only one such report in a case of disseminated varicella. The literature, insofar as it is pertinent, is reviewed and a synthesis References 1. Lennette, E.H., and Schmidt, N.J. (eds.): Diagnostic Procedures for Viral and Rickettsial Diseases , ed 3, New York: American Public Health Assoc., Inc., 1964, pp 120-121. 2. von Bokay, J.: Über den Ätiologischen Zusammenhang der Varizellen Mit Gewissen Fällen Von Herpes Zoster , Wien Klin Wschr 22:1323-1326, 1909. 3. Weller, T.H., and Coons, A.H.: Fluorescent Antibody Studies With Agents of Varicella and Herpes Zoster Propagated in Vitro , Proc Soc Exp Biol Med 86:789-794 ( (Aug-Sept) ) 1954.Crossref 4. Weller, T.H.; Witton, H.M.; and Bell, E.J.: Etiologic Agents of Varicella and Herpes Zoster , J Exp Med 108:843-868 ( (Dec) ) 1958.Crossref 5. Hope-Simpson, R.E.: The Nature of Herpes Zoster: A Long Term Study and a New Hypothesis , Proc Roy Soc Med 58:9-12 ( (Jan) ) 1965. 6. Downie, A.W.: Chickenpox and Zoster , Brit Med Bull 15:197-200 ( (Sept) ) 1959. 7. Robbins, S.L.: Pathology , ed 3, Philadelphia: W. B. Saunders Co., 1967, p 359. 8. Rhodes, A.J., and VanRooyen, C.E.: Textbook of Virology , ed 5, Baltimore: Williams & Wilkins Co, 1968, p 402. 9. Merselis, J.G.; Kaye, D.; and Hook, E.W.: Disseminated Herpes Zoster , Arch Intern Med 113:679-686 ( (May) ) 1964.Crossref 10. Bright, R.: Reports of Medical Cases , London: Longmans, Ltd., 1831, vol 2, pt 1, p 383. 11. von Bärensprung, F.G.F.: Beiträge zur Kenntnis des Zoster , Ann Charité-Krankenh 11:96-104 ( (No. 2) ) 1863. 12. Head, H., and Campbell, A.W.: The Pathology of Herpes Zoster and Its Bearing on Sensory Localization , Brain 23:23-519 ( (pt 3) ) 1900.Crossref 13. Lhermitte, J., and Nicolas, M.: Les lesions spinales du zona; la myélite zostérienne , Rev Neurol 1:361-364 ( (Feb 28) ) 1924. 14. Thalhimer, W.: Herpes Zoster: Central Nervous System Lesions Similar to Those of Epidemic (Lethargic) Encephalitis , Arch Neurol Psychiat 12:73-79 ( (July) ) 1924.Crossref 15. Denny-Brown, D.; Adams, R.D.; and Fitzgerald, P.J.: Pathologic Features of Herpes Zoster , Arch Neurol Psychiat 51:216-231 ( (March) ) 1944.Crossref 16. Lander, H.: A Case of Acute Haemorrhagic Leucoencephalitis (Hurst) Complicating Varicella , J Path Bact 70:157-165 ( (July) ) 1955.Crossref 17. Nicolaides, N.V.: Fatal Systemic Varicella: A Report of Three Cases , Med J Aust 2:88-91 ( (July 20) ) 1957. 18. Miller, H.G.; Stanton, J.B.; and Gibbon, J.L.: Para-Infectious Encephalomyelitis and Related Syndromes , Quart J Med 25:427-505 ( (Oct) ) 1956. 19. Rotem, C.: Complications of Chicken Pox , Brit Med J 1:944-947 ( (April 1) ) 1961.Crossref 20. Athanassiades, T., and Nicolopoulos, D.: Complications of Varicella , Lancet 2:403 ( (Aug 17) ) 1968.Crossref 21. Rinvik, R.: Congenital Varicella Encephalomyelitis in Surviving Newborn , Amer J Dis Child 117:231-235 ( (Feb) ) 1969. 22. Hassin, G.B., and Rabens, I.A.: Herpetic Meningoencephalitis , J Neuropath Exp Neurol 3:355-367 ( (Oct) ) 1944.Crossref 23. Boudin, G., et al: L'encéphalo-myélite zostérienne , Rev Neurol 99:535-537 ( (Nov) ) 1958. 24. Appelbaum, G.; Kreps, S.I.; and Sunshine, A.: Herpes Zoster Encephalitis , Amer J Med 32:25-31 ( (Jan) ) 1962.Crossref 25. Rose, F.C.; Brett, E.M.; and Burston, J.: Zoster Encephalomyelitis , Arch Neurol 11:155-172 ( (Aug) ) 1964.Crossref 26. Dunn, M., and Salter, R.H.: Zoster Encephalitis , Brit J Clin Pract 22:444-445 ( (Oct) ) 1968. 27. Tako, J., and Rado, J.P.: Zoster Meningoencephalitis in a Steroid-Treated Patient , Arch Neurol 12:610-612 ( (June) ) 1965.Crossref 28. Perier, O., et al: Etude Clinique et Anatomique de Deux Cas d'Encéphalite Zostérienne , Acta Neurol Belg 66:53-73, 1966. 29. Schirmer, A., and Regli, F.: Neurologische Komplikationen bei Herpes Zoster , Schweiz Med Wschr 97:731-735 ( (No. 23) ) 1967. 30. Haymaker, W., et al: " Pathology of Viral Disease in Man Characterized by Nuclear Inclusions ," in Fields, W.S., and Blattner (eds.): Viral Encephalitis , Springfield, Ill: Charles C Thomas, Publisher, 1958. 31. Gold, E.: Serologic and Virus Isolation Studies of Patients With Varicella or Herpes Zoster Infection , New Eng J Med 274:181-185 ( (Jan 27) ) 1966.Crossref 32. Cheatham, W.J., et al: Varicella: Report of Two Fatal Cases With Necropsy, Virus Isolation and Serologic Studies , Amer J Path 32:1015-1035 ( (Sept-Oct) ) 1956. 33. Muller, S.A.: Association of Zoster and Malignant Disorders in Children , Arch Derm 96:657-663 ( (Dec) ) 1967.Crossref 34. Ranney, E.K.; Norman, M.G.; and Silver, M.D.: Varicella Pneumonitis , Canad Med Assoc J 96:445-450 ( (Feb 25) ) 1967. 35. Keidan, S.E., and Mainwaring, D.: Association of Herpes Zoster With Leukemia and Lymphoma in Children , Clin Pediat 4:13-17 ( (Jan) ) 1965.Crossref 36. Sokal, V.E., and Firat, D.: Varicella-Zoster Infection in Hodgkin's Disease , Amer J Med 39:452-463 ( (Sept) ) 1965.Crossref 37. Casazza, A.R.; Duvall, C.P.; and Carbone, P.P.: Infection in Lymphoma , JAMA 197:710-716 ( (Aug 29) ) 1966.Crossref 38. Koehler, H.: Zur Pathogenese des Herpes zoster bei Systemerkrankngen, insbesondere bei Mykosis Fungoides , Der Hautarzt 19:16-20 ( (Jan) ) 1968. 39. Rifkind, D.: The Activation of Varicella-Zoster Virus Infection by Immunosuppressive Therapy , J Lab Clin Med 68:463-474 ( (Sept) ) 1966. 40. Ultmann, J.E., et al: The Clinical Implications of Hypogammaglobulinemia in Patients With Chronic Lymphocytic Leukemia and Lymphosarcoma , Ann Intern Med 51:501-516 ( (Sept) ) 1959.Crossref 41. Elliot, F.A.: Shingles , Lancet 2:170-171 ( (July 20) ) 1968.Crossref 42. Sabin, A.B., and Koch, M.A.: Behavior of Non-infectious SV40 Viral Genome in Hamster Tumor Cells: Induction of Synthesis of Infectious Virus , Proc Nat Acad Sci 50:407-417 ( (Sept 15) ) 1963.Crossref 43. Hook, E.B., et al: Familial Fatal Varicella , JAMA 206:305-311 ( (Oct 7) ) 1968.Crossref 44. Suzuki, Y.: Neurological Complications of Varicella , Adv Neurol Sci 11:887-896 ( (Dec) ) 1967. 45. Lutzner, M.A.: Fine Structure of the Zoster Virus in Human Skin , J Ultrastruct Res 7:409-417 ( (Dec) ) 1962.Crossref 46. Tournier, P.; Cathala, F.; and Bernhard, W.: Ultrastructure et Développment Intracellulaire du Virus de la Varicelle Observé en Microscope Electronique , Presse Med 65:1229-1234 ( (June 29) ) 1957. 47. Kaplan, A.S.: Herpes Simplex and Pseudorabies Viruses , New York: Springer-Verlag, 1969. 48. McKee, A.P., et al: Herpes Simplex Encephalitis , Southern Med J 61:217-225 ( (March) ) 1968.Crossref 49. Swanson, J.L.; Craighead, J.E.; and Reynolds, E.S.: Electron Microscopic Observations on Herpesvirus hominis (Herpes Simplex Virus) Encephalitis in Man , Lab Invest 15:1966-1981 ( (Dec) ) 1966. 50. Bennett, D.R.; ZuRhein, G.M.; and Roberts, T.S.: Acute Necrotizing Encephalitis , Arch Neurol 6:96-113 ( (Feb) ) 1962.Crossref 51. Adams, J.H., and Jennett, W.B.: Acute Necrotizing Encephalitis: A Problem in Diagnosis , J Neurol Neurosurg Psychiat 30:248-260 ( (April) ) 1967.Crossref 52. Johnson, R.T.; Olson, L.C.; and Buescher, E.L.: Herpes Simplex Virus Infections of the Nervous System , Arch Neurol 18:260-264 ( (March) ) 1968.Crossref 53. Lynfield, Y.L.; Farhangi, M.; and Runnels, J.L.: Generalized Herpes Simplex Complicating Lymphoma , JAMA 207:944-945 ( (Feb 3) ) 1969.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Dec 1, 1969

References