Detection of Varicella Zoster Virus DNA in Tear Fluid and Saliva of Patients with Ramsay Hunt Syndrome

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Abstract
To clarify the dynamics of the reactivation of the varicella zoster virus in Ramsay Hunt syndrome. Varicella zoster virus DNA in the tear fluid, submandibular gland saliva, and parotid gland saliva of 15 patients with Ramsay Hunt syndrome was studied. The presence of varicella zoster virus DNA was detected quantitatively by the use of polymerase chain reaction and a microplate hybridization method. Of 102 specimens of the tear fluid and saliva collected from 15 patients, varicella zoster virus DNA was detected in 40 specimens (39%) from 12 patients (80%). The detection rate was 72% in the submandibular saliva, 57% in the parotid saliva, and 27% in the tear fluid. Varicella zoster virus DNA was detected not only in specimens from the affected side but also in specimens from the unaffected side at the same rate of detection, and at nearly the same number of DNA copies. Regarding the parotid saliva, varicella zoster virus DNA was detected in samples collected at an early stage of the disease. In the tear fluid and submandibular saliva, however, the detection rate was high in samples collected 2 weeks after the onset of disease or later. Secretion of varicella zoster virus DNA into the tear fluid and saliva was confirmed in the patient with Ramsay Hunt syndrome. The increase and decrease in the detection rate and the number of varicella zoster virus DNA copies detected in samples collected at different times was considered to substantiate varicella zoster virus reactivation in Ramsay Hunt syndrome. Varicella zoster virus reactivation was thought to occur in the unaffected side at the same level as in the affected side, and some of the secreted varicella zoster virus DNA was suspected to be derived from the ganglion trigeminale.