Congenital varicella-zoster virus infection after maternal subclinical infection: clinical and neuropathological findings.

OBJECTIVE

It is known that varicella-zoster virus (VZV) can cause asymptomatic infections, but it has not been described that congenital infection can be caused by maternal subclinical infection. The purpose of this study is to evaluate clinical and neuropathologic findings of infants with neonatal seizures and cerebrospinal fluid (CSF) VZV antibodies, but no maternal clinical VZV infection during the pregnancy.

METHODS

Screening of 201 neonates were studied for congenital viral infections, because of neurologic problems of unknown origin. Antibodies to 16 different microbes were investigated from the CSF and the serum of the neonates, as well as from the first trimester and postpartum serum of their mothers. Clinical symptoms and signs as well as neuropathology of those infants with antibodies to VZV in CSF were evaluated in this study.

RESULTS

Four neonates with antibodies to VZV in CSF were identified and CSF findings were reported earlier. Their mothers had laboratory evidence of infection, based on a significant rise in serum VZV antibody level during pregnancy in three mothers, and a constantly high antibody level to VZV in one mother. All four children had seizures and abnormalities in muscular tone during the neonatal period, but no typical manifestations of a congenital VZV infection. One child died at the age of 4 months. At autopsy, neuropathologic examination showed foci of astrocytic hyperplasia and hypertrophy but no specific signs of viral infection.

CONCLUSIONS

Maternal subclinical VZV infection can cause congenital infection with neurologic symptoms and signs in the child.