Encephalitis, meningitis, and acute cerebellar ataxia as neurological complications of VZV infection in children. A retrospective study

Aim of the study
Varicella is a disease with potentially severe complications. The objective of this study was to assess the specific clinical picture of neurological complications of VZV in the form of encephalitis, meningitis, and acute cerebellar ataxia among hospitalised children.

Material and methods
The study was designed as a retrospective analysis, based on reviewing the medical records and collecting post-hospitalisation questionnaires of children admitted to the hospital for varicella complications between January 2009 and December 2018. None of the patients was vaccinated. Patients were divided into groups based on the type of neurological diagnosis. We analysed the results of the additional tests performed, their significance for the final diagnosis, and predictive validity. Statistical analysis of data was performed, and the results were compared with available data.

Results
A link between age and type of neurological complication was found. Diversity in the length of hospitalisation as well as in the number of additional tests necessary for a final diagnosis was established. None of the analysed clinical parameters and additional tests was found to be a potential predictor linked with the possibility of sequels in our study. Children with encephalitis had a significantly higher risk of neurological sequelae at the moment of discharge.

Conclusions
Acute cerebellar ataxia was the most frequent neurological complication, while encephalitis was associated with increased risk of neurological sequel. Direct presence of VZV-DNA was observed in patients with meningitis, while acute cerebellar ataxia and encephalitis were a result of an immune response. The presented results serve as a reminder of the potential severity of chickenpox in unvaccinated, otherwise immunocompetent children.