A study of 368 patients with aseptic meningitis admitted to the Los Angeles County General Hospital in 1958 failed to identify VZV as a possible etiologic agent in any of these patients (Lennette 1962), likely due to the techniques used to identify VZV, i.e., inoculation of stool cultures into monkey kidney cells and into 1-day-old mice. viral DNA was no longer found in the CSF, glucose levels in CSF remained low. Hypoglycorrhachia with VZV infection has been reported CP 316311 in zoster meningitis of immunocompetent adults (Echevarria 1987; Moriuchi 1997), even in the absence of rash (Mayo and Booss, 1989) and in children (Jhaveri 2003; Leahy 2008), as confirmed by PCR and serology. Hypoglycorrhachia has also been found in VZV meningoencephalitis after ophthalmic distribution zoster (Reimer and Beller, 1981; Norris 1970) and in zoster polyneuritis with no rash (Mayo and Booss, 1989). In the past, VZV was considered to be a rare cause of viral meningitis. A survey of 368 patients with aseptic meningitis admitted to the Los Angeles County General Hospital in 1958 failed to identify VZV as a CP 316311 possible etiologic agent in any of these patients (Lennette 1962), likely due to the techniques used to identify VZV, i.e., inoculation of stool Rabbit Polyclonal to ZNF682 cultures into monkey kidney cells and into 1-day-old mice. VZV isolation from CSF or stool is rare, and VZV is an exclusively human virus that does not produce disease after experimental infection of mice (Wroblewska 1982). More recently, proof that VZV can cause serious neurological disease, often in the absence of rash, has been based on serologic analyses to CP 316311 detect VZV-specific antibodies (Shoji 1976), as well as intracellular antigen in patients with zoster meningoencephalitis, cranial and spinal radiculoneuritis (Peters 1979), and intrathecal production of anti-VZV antibodies (Martinez-Martin 1985; Echevarria 1987). Most recently, combined PCR and antibody testing revealed that VZV causes 5% to 27% of all aseptic meningitis (Koskiniemi 2001; Hausfater 2004; Kupila 2006; Frantzidou 2008), which is not altogether surprising because PCR has already shown that VZV causes zoster sine herpete (Gilden 1994), vasculopathy (Gilden 1996), acute (Gilden, 1994) and recurrent (Gilden 2009) myelopathy, acute cerebellar ataxia (Moses 2006; Ratzka 2006), and retinal necrosis (el Azazi 1991; Galindez 1996), all without rash. Viruses that can cause aseptic meningitis with hypoglycorrhachia include lymphocytic choriomeningitis virus (Jamieson 1986) and mumps virus (Wilfert, 1969), as well as ECHO (Mirani 1973) and Coxsackie (Marier 1975) viruses in children. Now, VZV can be added to this list. PCR analysis, especially CP 316311 in the first week of acute symptoms of meningitis, with or without VZV rash, is essential in accurate diagnosis and treatment. Acknowledgments This work was supported in part by Public Health Service grants AG 006127 and NS 32623 from the National Institutes of Health. The authors thank Cathy Allen for preparing the manuscript. Footnotes Declaration of interest: The authors report no conflicts of interest. CP 316311 The authors alone are responsible for the content and writing of the paper. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control & Prevention..