Neonatal Varicella-Zoster Virus Meningitis Without Pleocytosis: Diagnostic Value of Polymerase Chain Reaction
Year: 2026
Type: article
Study design: Case Report
Abstract: Neonatal varicella is uncommon but may lead to severe complications, including central nervous system involvement. Cerebrospinal fluid findings may be misleading in neonates, and polymerase chain reaction-confirmed viral central nervous system infection may occur without pleocytosis, particularly when lumbar puncture is performed early in the course of illness. We report a 17-day-old term male neonate admitted with generalized vesicular rash and fever associated with irritability and poor feeding. Lumbar puncture performed on admission showed normal cerebrospinal fluid parameters without pleocytosis; however, a multiplex cerebrospinal fluid polymerase chain reaction panel was positive for varicella-zoster virus, and vesicular lesion polymerase chain reaction confirmed varicella-zoster virus infection. The neonate received intravenous acyclovir for 21 days with complete clinical recovery and normal follow-up. This case highlights that a normal cerebrospinal fluid cell count does not exclude neonatal viral central nervous system infection and supports early cerebrospinal fluid polymerase chain reaction testing to confirm varicella-zoster virus central nervous system involvement while rapidly excluding major differentials such as neonatal herpes simplex virus infection.
Source: Cureus
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7150796312