Journal of Clinical Virology 25 (2002) 293 – 301 Acute central nervous system complications in varicella zoster virus infections Marjaleena Koskiniemi a,b, *, Heli Piiparinen b , Timo Rantalaiho a , Pekka Era ¨nko ¨ c , Markus Fa ¨rkkila ¨ b , Kirsti Ra ¨iha ¨ b , Eeva-Marjatta Salonen b , Pentti Ukkonen b , Antti Vaheri a,b , The Study Group 1 a Department of Virology, Haartman Institute, Helsinki Uniersity, POB 21, FIN 00014 Helsinki, Finland b Helsinki Uniersity Central Hospital, Uniersity of Helsinki, Helsinki, Finland c Glaxo Wellcome Pharmaceutical Company, Helsinki, Finland Abstract Background : In a previous multicenter study on central nervous system (CNS) viral infections varicella zoster virus (VZV) appeared the most frequent etiologic agent and appeared often without rash. Objectie : To evaluate the appearance and diagnostics of VZV in CNS more thoroughly, we studied the cases systematically by using sensitive and specific methods to learn the best diagnostic approach in order to start specific therapy. Study design : We analyzed all serum and cerebrospinal fluid samples of 174 patients, 88 females and 86 males, with acute CNS symptoms associated with VZV infection diagnosed in the multicenter study on viral CNS infections. Results : About 38 patients (22%) had chickenpox, 59 (34%) had shingles, and 77 (44%) had no cutaneous symptoms at all. The mean age of chickenpox patients was 8.6 years, of the others 46.6 and 41.4 years. VZV-specific nucleic acid was detected in the CSF in one fourth of the patients in all groups, primarily during the first week of illness. In serum specimens, www.elsevier.com/locate/jcv Abbreiations: CNS, central nervous system; CSF, cerebrospinal fluid; HSV, herpes simplex virus; VZV, varicella zoster virus; PCR, polymerase chain reaction. * Corresponding author. Tel.: +358-919-126-579; fax: +358-919-126-491 E-mail address: marjaleena.koskiniemi@helsinki.fi (M. Koskiniemi). 1 Study Group: Asko Ja ¨rvinen, Esko Kinnunen, Suvi Koskiniemi, Laura Mannonen, Marketta Muttilainen, Kimmo Linnavuori, Jukka Porras, Mirja Puolakkainen, Ville Valtonen, Helsinki University Central Hospital; Marjo-Riitta Aine, Matti Junes, Central Hospital of Lapland, Rovaniemi; Vilho Myllyla ¨, Heikki Rantala, Anne Saari, Oulu University Hospital, Oulu; Roger Byring, Lauri Hakamies, Harri Kivela ¨, Bjarne Udd, Vaasa Central Hospital, Vaasa; Merja Kaislakoski, Kirsi Mustonen, Annamari Juntunen, Central Hospital of North Karelia, Joensuu; Heidi Fagerstro ¨m, Dag Nyman, A  land Central Hospital, Mariehamn; Niilo-Pekka Huttunen, Taneli Sarasoja, Central Hospital of Central Finland, Jyva ¨skyla ¨; Eila Herrga ˚rd, Matti Korppi, Juho Nuutinen, Kuopio University Hospital, Kuopio; Juhani Gro ¨ nlund, Ulla Kaski, Ritva Norja, Central Hospital of South Pohjanmaa, Seina ¨joki; Christine Hedman, Ulla-Maija Ritanen-Mohammed, Central Hospital of Pa ¨ija ¨t-Ha ¨me, Lahti; Helena Pesonen, Ari Saarinen, Kajaani Central Hospital, Kajaani; Ilkka Pieninkeroinen, Tiina Wallden, Central Hospital of Kymenlaakso, Kotka; Pentti Lautala, Raili Saari, Jussi Valpas, Central Hospital of South Karelia, Lappeenranta; Juhani Sankala, Hannu Kilpela ¨inen, Savonlinna Central Hospital, Savonlinna; Pirkko Karttunen, Matti Pere, Anja Selonen, Jaakko Taalas, Mikkeli Central Hospital, Mikkeli; Seppo Mannila, Kari Uotila, Central Hospital of Kanta-Ha ¨me, Ha ¨meenlinna; Seppo Tuisku, Markus Va ¨re, Central Hospital of Central Pohjanmaa, Kokkola; Finland. 1386-6532/02/$ - see front matter. Crown Copyright © 2002 Published by Elsevier Science B.V. All rights reserved. PII:S1386-6532(02)00020-3