Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.
Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
Clin Infect Dis. 2021 Apr 8;72(7):1192-1199. doi: 10.1093/cid/ciaa185.
Knowledge of the epidemiology and clinical characteristics of varicella zoster virus (VZV) encephalitis remains limited.
Nationwide prospective cohort study of adults treated for microbiologically confirmed VZV encephalitis at Danish departments of infectious diseases from 2015 to 2019. Modified Poisson regression analysis was used to compute adjusted relative risks (RRs) of unfavorable outcome.
We identified 92 adults (49% female) with VZV encephalitis, yielding an incidence of 5.3/1 000 000 per year (95% CI, 4.2-6.6). Median age was 75 years (IQR, 67-83) and immunocompromising conditions were frequent (39%). Predominant symptoms were confusion (76%), headache (56%), nausea (45%), gait disturbance (42%), and personality changes (41%). Cranial imaging showed cerebral vasculitis (including infarction and hemorrhage) in 14 (16%) patients and encephalitic abnormalities in 11 (13%) with predilection for the brainstem and deep brain structures. Intravenous acyclovir treatment was initiated a median (IQR) of 13.4 hours (5.2-46.3) since admission, while cranial imaging and lumbar puncture were performed after 6.3 hours (2.5-31.0) and 18.5 hours (4.9-42.0). In-hospital, 1-month, and 3-month mortalities were 4%, 9%, and 11%, respectively. Unfavorable outcome (Glasgow Outcome Score of 1-4) was found in 69% at discharge, with age (adjusted RR [aRR], 1.02; 95% CI, 1.01-1.03), vasculitis (aRR, 1.38; 95% CI, 1.02-1.86), and Glasgow Coma Scale (GCS) <15 (aRR, 1.32; 95% CI, 1.01-1.73) identified as independent risk factors.
VZV encephalitis occurs primarily in elderly or immunocompromised patients with a higher incidence than previously estimated. The diagnosis is often delayed; risk factors for unfavorable outcome are age, cerebral vasculitis, and GCS <15.
水痘带状疱疹病毒（VZV）脑炎的流行病学和临床特征仍知之甚少。
这是一项在丹麦传染病科对 2015 年至 2019 年期间确诊为 VZV 脑炎的成年人进行的全国性前瞻性队列研究。采用校正泊松回归分析计算不良结局的调整相对风险（RR）。
我们共发现 92 例 VZV 脑炎成人患者（49%为女性），发病率为每年 5.3/100 万（95%CI，4.2-6.6）。中位年龄为 75 岁（IQR，67-83 岁），免疫功能低下的情况很常见（39%）。主要症状包括意识混乱（76%）、头痛（56%）、恶心（45%）、步态障碍（42%）和人格改变（41%）。14 例（16%）患者存在颅脑血管炎（包括梗死和出血），11 例（13%）患者存在脑炎异常，病变部位以脑干和深部脑结构为主。静脉用阿昔洛韦治疗的中位（IQR）起始时间为入院后 13.4 小时（5.2-46.3），而头颅影像学和腰椎穿刺的中位（IQR）检查时间分别为入院后 6.3 小时（2.5-31.0）和 18.5 小时（4.9-42.0）。住院期间、1 个月和 3 个月的死亡率分别为 4%、9%和 11%。出院时，格拉斯哥预后评分（GOS）为 1-4 分的不良预后者占 69%，年龄（校正 RR [aRR]，1.02；95%CI，1.01-1.03）、血管炎（aRR，1.38；95%CI，1.02-1.86）和格拉斯哥昏迷量表（GCS）评分<15（aRR，1.32；95%CI，1.01-1.73）为独立危险因素。
VZV 脑炎主要发生在老年人或免疫功能低下的患者中，其发病率高于以往估计。该疾病的诊断通常较为延迟；不良结局的危险因素为年龄、脑血管炎和 GCS<15。
