Please cite this article in press as: Tabaja H, et al. Varicella zoster virus infection of the central nervous system in a tertiary care center in Lebanon. Med Mal Infect (2019), https://doi.org/10.1016/j.medmal.2019.08.005 ARTICLE IN PRESS G Model MEDMAL-4197; No. of Pages 8 Médecine et maladies infectieuses xxx (2019) xxx–xxx Disponible en ligne sur ScienceDirect www.sciencedirect.com Original article Varicella zoster virus infection of the central nervous system in a tertiary care center in Lebanon Infection à virus varicelle-zona du système nerveux central dans un centre de soins tertiaires au Liban H. Tabaja a,1 , S.L. Sharara b,1 , Y. Abi Aad a,b,1 , N. Beydoun b,1 , S. Tabbal c , A. Makki c , R. Mahfouz d , S.S. Kanj a,∗ a Infectious Diseases Unit, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon b The School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon c The division of Neurology, American University of Beirut Medical Center, Beirut, Lebanon d The division of Diagnostic Molecular Pathology, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon a r t i c l e i n f o Article history: Received 17 June 2018 Received in revised form 20 August 2018 Accepted 27 August 2019 Available online xxx Keywords: Encephalitis Meningitis Meningoencephalitis Varicella zoster virus a b s t r a c t Objective. – To describe the clinical manifestations and treatment outcomes of patients with VZV menin- gitis and encephalitis consulting at two medical centers in Lebanon. Methods. – Retrospective study of patients with VZV meningitis and/or encephalitis confirmed by positive cerebrospinal fluid (CSF) VZV PCR. Results. – Twenty patients were identified (13 males). The average age was 49.7 ± 22.2 years. The most common complaint was headache (n = 17/20). Common comorbidities included hypertension (n = 7/20) and diabetes mellitus (n = 5/20). Immunosuppression was reported in two patients. Vesicles were only observed in eight patients. Altered mental status, focal neurological deficits, and fever were documented in six, two, and four patients respectively. All patients had CSF leukocytosis with lymphocytic predom- inance, normal CSF/serum glucose ratio, and high CSF protein. Eighteen patients had brain CT scans showing no relevant findings. Two of 12 patients with brain MRI had focal abnormalities. Unilateral tem- poral slow waves were observed in three of four patients who underwent electroencephalograms. Four patients had encephalitis and 16 had meningitis. Eighteen patients received an antiviral therapy. Treat- ment either included intravenous acyclovir or oral valacyclovir. The encephalitis and meningitis groups had comparable mean duration of treatment (13.5 ± 6.6 vs. 12.2 ± 5.4, respectively). All admitted patients showed clinical cure with no reported neurological sequelae. Conclusion. – VZV infection should be suspected in any patient with signs and symptoms of viral menin- gitis or encephalitis, irrespective of age, immune status, presence or absence of vesicles, fever, or neck stiffness. © 2019 Elsevier Masson SAS. All rights reserved. Mots clés : Encéphalite Méningite Méningoencéphalite Virus varicelle-zoster r é s u m é Objectif. – Décrire les manifestations cliniques et les résultats thérapeutiques des patients atteints de méningite ou d’encéphalite à VZV dans deux centres médicaux libanais. Méthodes. – Étude rétrospective de patients atteints de méningite et/ou d’encéphalite à VZV confirmées par PCR dans le liquide cephalorachidien. Résultats. – Vingt patients ont été identifiés, dont 13 hommes. L’âge moyen était de 49,7 ± 22,2 ans. Le symptôme le plus commun était les céphalées (n = 17/20). Les comorbidités incluaient l’hypertension (n = 7/20) et le diabète (n = 5/20). Deux patients étaient immunodéprimés. L’éruption cutanée était ∗ Corresponding author. E-mail address: sk11@aub.edu.lb (S.S. Kanj). 1 H. Tabaja and S.L Sharara have contributed equally as primary authors while Y. Abi Aad and N. Beydoun have contributed equally as secondary authors on this paper. https://doi.org/10.1016/j.medmal.2019.08.005 0399-077X/© 2019 Elsevier Masson SAS. All rights reserved.