Received: 17 September 2017
Accepted: 24 December 2017
Characteristics of patients with acute peripheral facial palsy
showing Varicella zoster virus DNA in saliva
Dong Sik Chang
Sun Ae Shin
Ho Yun Lee
Department of Otorhinolaryngology, Eulji
University Hospital, Eulji University, Daejeon,
Republic of Korea
Department of Medical Science, Chungnam
National University, Daejeon, Korea
Ho Y. Lee, MD, PhD, Department of
Otorhinolaryngology, Eulji University Hospital,
Eulji University, Dunsanseo-ro 95, Seo-Gu,
Daejeon 35233, South Korea.
National Research Foundation of Korea,
Grant number: NRF-2017R1C1B5017839;
EMBRI GRANTS, Grant numbers: 2015
Infection caused by Varicella zoster virus (VZV) is a common etiology of acute peripheral
facial palsy (APFP). We aimed to assess the clinical significance of detecting VZV DNA
from the saliva of patients with APFP. Saliva collected from 36 patients with unilateral
APFP at initial visit was analyzed to detect VZV DNA by polymerase chain reaction. The
House-Brackmann (HB) scale was used to evaluate FP severity on admission day, at
week 2, and at weeks 10-12 after start of treatment. Among the 28 patients without
rash, VZV DNA was detected in 3 patients (10.7%); 6 of 8 patients (75.0%) with rash
showed VZV DNA (P = 0.001). VZV DNA-positive patients had worse hearing than
VZV DNA-negative patients (P < 0.05). A significantly higher proportion of VZV DNA-
negative patients (96.3%) showed complete recovery than VZV DNA-positive patients
(55.6%) (P = 0.006). In conclusion, VZV DNA-positive patients had worse hearing and
incomplete recovery compared to VZV DNA-negative patients, irrespective of the
presence of rash. Tests for the detection of VZV DNA in saliva may be helpful for early
differential diagnosis and choosing an appropriate medical treatment of APFP.
acute peripheral facial palsy, hearing, polymerase chain reaction, prognosis, varicella zoster
Infection is one of the most commonly identified etiologies of acute
peripheral facial palsy (APFP). Causative organisms such as Borrelia
burgodoferi, Varicella zoster virus (VZV), and Herpes simplex virus (HSV)
are often detected in the cerebrospinal fluid of patients with APFP.
the past, reactivation of HSV-1 was believed to be the main cause of
Bell's palsy (BP);
however, a recent other study reported a potential
association between BP and another HSV, Human herpesvirus 6.
Approximately 8-28% of BP cases is caused by VZV infection, and such
cases are classified separately as zoster sine herpete (ZSH).
. One of
the most-representative VZV infections—the Ramsay-Hunt syndrome
—presents as a vesicular eruption in the external auditory canal or
oropharynx and is sometimes accompanied by vestibulocochlear
dysfunction in APFP patients.
Although the recent American guidelines recommend against routine
laboratory testing, confirmation of reactivated VZV requires laboratory
testing, as it is impossible to differentiate ZSH from BP without laboratory
This differential diagnosis is important because the dose of
antiviral agent required might differ on the basis of the pathogen and the
final recovery rate differs between ZSH and BP.
For detection of VZV or HSV, the antibody titers against these
viruses can be measured by enzyme-linked immunosorbent assay
(ELISA). Recent infection can be detected by an increase in the titer of
immunoglobulin (Ig) M above the baseline value. However, at least
2 weeks are required to compare the IgG titers in paired sera for
confirmation of viral reactivation.
Usually, reactivation of the virus is
confirmed when the titer from the sample collected at 2-3 weeks
shows a 2- to 4-fold increase from the sample collected at initial
J Med Virol. 2018;90:959–964. wileyonlinelibrary.com/journal/jmv © 2018 Wiley Periodicals, Inc.