Varicella zoster virus and meningitis in immunocompetent patients: Specificity and questions

Varicella-zoster virus (VZV) is the causative agent for high-mortality-rate meningoencephalitis in immunocompromised patients, but there it can cause meningitis in immunocompetent patients. The purpose of this study was to describe the characteristics and clinical course of symptomatic VZV meningitis occuring in immunocompetent patients without encephalitis. We used the Clermont-Ferrand University Hospital Laboratories database to select the files of adult patients from June 2015 to August 2017 with lymphocytic CSF pleocytosis and/or VZV-positive PCR on CSF analysis. Then, the medical files of this patients were analysed. We focused on immunocompetent patients with acute isolated clinical meningitis, lymphocytic CSF pleocytosis and/or VZV-positive PCR on CSF analysis and bacterial culture-negative CSF. In total, 325 adult patients meet the screening criteria. Forty patients met criteria for analysis: lymphocytic CSF pleocytosis, immunocompetent patient, acute clinical isolated meningitis. PCR in LCR detected Enterovirus in 19 patients and VZV in 5 patients. Median age of this 5 patients was 33 years and 3/5 had cutaneous lesions, which in 2 cases were found on later examination. Median duration of antiviral therapy was 10 days (range 10–14), including a first 5 days (range 5–7) of IV delivery. Clinical course was favorable in every case. Clinical meningitis related to VZV reactivation can occur in young immunocompetent patients. Shingles typical rash can be discrete or absent. Clinical course was favorable in every case, raising the question of whether there is a rationale for systematic IV antiviral therapy. Early oral antiviral therapy would probably be a reasonable option.