Korean J Dermatol.
2023 Dec;61(10):612-619.
Comparative Analysis of Clinical Features and Serological Findings of Herpes Zoster and Zoster Meningitis
- Affiliations
-
- 1Department of Dermatology, Chosun University College of Medicine, Gwangju, Korea
Abstract
- Background
Herpes zoster is a viral infection caused by reactivation of the varicella-zoster virus (VZV). VZV can also cause infection of the central nervous system, such as meningitis. There are relatively few studies investigating the clinical features and serological findings differentiating herpes zoster and zoster meningitis.
Objective
To compare clinical features and serological findings of zoster meningitis and herpes zoster without meningitis.
Methods
We retrospectively analyzed the medical records of 473 patients with herpes zoster or zoster meningitis admitted in our hospital between May 2017 to June 2022. We investigated the patients’ underlying comorbidities, clinical features and laboratory findings including fever, headache, nausea/vomiting, dizziness, meningeal irritation sign, dermatomal distribution, skin inflammation severity, initial pain numeric rating scale (NRS) at the initial visit, serum VZV immunoglobulin M (IgM) and G (IgG) titer, serum VZV polymerase chain reaction (PCR) and cerebrospinal fluid (CSF) analysis.
Results
Overall, 410 patients with herpes zoster and 63 patients with zoster meningitis were included. No significant differences in age, serum VZV IgM, VZV PCR and skin inflammation severity were found between groups. Initial pain NRS was higher significantly in zoster meningitis group (herpes zoster group: 4.8±2.1, zoster meningitis group: 5.7±2.2) (p=0.003) and mean VZV IgG was lower in zoster meningitis group (herpes zoster group: 2,506±1,345.8, zoster meningitis group: 1,712±1,796.3 mIU/mL) (p=0.028).
Conclusion
No typical symptoms of meningitis are found in case of trigeminal nerve involvement. Moreover, if there is severe initial pain or low levels of serum VZV IgG are detected, further evaluations such as CSF tapping may be necessary to differentiate zoster meningitis from herpes zoster.
