CHARACTERISTICS OF RARE NEUROLOGICAL COMPLICATIONS OF VARICELLA INFECTION IN CHILDREN

Objectives: To analyze the characteristics of complications of primary varicella-zoster virus (VZV) infection at a single neuropediatric clinic.

Methods: We retrospectively analyzed the chickenpox-related neurological complications at our clinic in the period 2000–2005. A total of 167 medical charts of children with para- or postinfectious neurological diseases were analyzed. Cases with acute cerebellar ataxia were excluded.

Results: During this period, 9 cases were found to have had serious central nervous system (CNS) involvements during varicella. They presented following conditions: acute disseminated encephalomyelitis (n=3); first attack of multiple sclerosis (n=1); relapsing bilateral optic neuritis (n=1); bilateral neuroretinovasculitis (n=1); ischemic stroke due to focal vasculitis (n=1); and protracted unilateral peripheral facial palsy (n=2). In all children neuroimaging, cerebro-spinal fluid (CSF), virological and immunological investigations have been performed. In patients with central demyelination, oligoclonal bands in CSF were found, and magnetic resonance imaging changes were typical for white matter damage. In patients with visual system complications, only isolated changes in ocular fundi have been observed. The VZV IgM antibodies' titers in serum were high in all patients. In none of the cases were VZV antibodies found in CSF. The treatment included corticosteroids (n=9) and acyclovir (n=1). In 6 out of 9 patients a full recovery was observed.

Conclusion: Although rare, the neurological complications after primary VZV infection in childhood had very variable presentation. Demyelinating disorders of brain white matter or optic nerves were the most common. Purposeful treatment with anti-inflammatory agents led to complete regression of pathological changes in the majority of our patients and could be recommended in cases with CNS involvement. Acyclovir therapy could be preserved for cases with ocular VZV-complication or in patients with severe disease course.