Journal article
Detection of Varicella Zoster Virus Reactivation in Cerebrospinal Fluid in Ischemic Stroke or Transient Ischemic Attack
Journal of the American Heart Association, Vol.14(13), e039489
07/01/2025
DOI: 10.1161/JAHA.124.039489
PMCID: PMC12449971
PMID: 40530491
Abstract
Epidemiological data suggest that the risk of ischemic stroke increases after varicella-zoster virus (VZV) reactivation. The frequency of VZV reactivation in acute ischemic stroke (AIS) is unknown. The risk of recurrent stroke and the antiviral treatment effect, particularly in patients with HIV infection, have yet to be defined. Here, we investigate the proportion of VZV reactivation in the cerebrospinal fluid (CSF) of patients who presented with AIS or transient ischemic attack and underwent VZV testing, along with relevant follow-up information.
We retrospectively reviewed medical records of patients who presented with AIS or transient ischemic attack and underwent VZV polymerase chain reaction and anti-VZV IgG testing in CSF during their workup from January 1, 2014, to December 31, 2021. VZV reactivation was confirmed by a positive VZV polymerase chain reaction result or increased intrathecal anti-VZV IgG synthesis in CSF. The cause of AIS and transient ischemic attack was classified using the SSS-TOAST (Stop Stroke Study-Trial of ORG 10172 in Acute Stroke Treatment) criteria. The occurrence of recurrent ischemic stroke during follow-up was compared between patients who received antiviral treatment and those who did not, as well as between patients with and without HIV.
Among the 177 patients included, VZV reactivation in CSF was found in 23.2%. VZV reactivation was more common in strokes involving intracranial arteries compared with those that did not (28% versus 3%,
=0.01). Seven (17%) patients with VZV reactivation had recurrent ischemic stroke within 1 year from positive test results. There was no significant difference in recurrent ischemic stroke between patients who received short-term antiviral therapy and those who did not (14.8% versus 21%,
=0.593). Patients with AIS and HIV had a significantly higher risk of VZV reactivation (57% versus 20%,
=0.002) and recurrent ischemic stroke despite antiviral treatment (42.8% versus 5.0%,
=0.02) compared with patients without HIV.
Among individuals who underwent VZV testing in CSF, VZV reactivation was present in 1 of 5 patients with AIS/transient ischemic attack. Patients with HIV were at particularly high risk of VZV reactivation and recurrent ischemic stroke.
Details
- Title: Subtitle
- Detection of Varicella Zoster Virus Reactivation in Cerebrospinal Fluid in Ischemic Stroke or Transient Ischemic Attack
- Creators
- Wenyang Li - The University of Texas Southwestern Medical CenterPeter Sguigna - The University of Texas Southwestern Medical CenterChintan Rupareliya - The University of Texas Southwestern Medical CenterSuriya Subramanian - The University of Texas Southwestern Medical CenterHisham Salahuddin - Antelope Valley HospitalKhalil S Husari - University of BaltimoreWilliam Moore - The University of Texas Southwestern Medical CenterMark Johnson - The University of Texas Southwestern Medical CenterAlejandro Magadan - The University of Texas Southwestern Medical CenterCharles Grose - University of IowaAnk E Nijhawan - The University of Texas Southwestern Medical CenterTy Shang - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of the American Heart Association, Vol.14(13), e039489
- DOI
- 10.1161/JAHA.124.039489
- PMID
- 40530491
- PMCID
- PMC12449971
- NLM abbreviation
- J Am Heart Assoc
- ISSN
- 2047-9980
- eISSN
- 2047-9980
- Publisher
- WILEY
- Grant note
- National Institutes of Health grant: AI153817
There is no funding for this retrospective stroke study. Research by Charles Grose on varicella virus pathogenesis is supported by National Institutes of Health grant AI153817.
- Language
- English
- Electronic publication date
- 06/18/2025
- Date published
- 07/01/2025
- Academic Unit
- Stead Family Department of Pediatrics; Infectious Disease (Pediatrics)
- Record Identifier
- 9984832089302771
Metrics
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