Corral Carlos, Quereda Carmen, Muriel Alfonso, Martínez-Ulloa Pedro-Luis, González-Gómez Francisco-Javier, Corral Íñigo
Department of Neurology, University Hospital Ramón y Cajal, Madrid, Spain.
Department of Infectious Diseases, University Hospital Ramón y Cajal, Madrid, Spain.
J Neurovirol. 2020 Oct;26(5):696-703. doi: 10.1007/s13365-020-00872-x. Epub 2020 Jul 21.
Immunosuppressed patients are at higher risk for developing herpes zoster (HZ), and neurological complications are frequent in them. However, the influence of immunosuppression (IS) on the severity and prognosis of neurological complications of varicella-zoster virus (VZV) reactivation is unknown. We studied retrospectively patients with neurological complications due to VZV reactivation who attended our hospital between 2004 and 2019. We aimed to assess the clinical spectrum, potential prognostic factors, and the influence of the immune status on the severity of neurological symptoms. A total of 98 patients were included (40% had IS). Fifty-five patients (56%) had cranial neuropathies which included Ramsay-Hunt syndrome (36 patients) and cranial multineuritis (23 patients). Twenty-one patients developed encephalitis (21%). Other diagnosis included radiculopathies, meningitis, vasculitis, or myelitis (15, 10, 6, and 4 patients, respectively). Mortality was low (3%). At follow-up, 24% of patients had persistent symptoms although these were usually mild. IS was associated with severity (defined as a modified Rankin scale greater than 2) (odds ratio, 4.23; 95% confidence interval, 1.74-10.27), but not with prognosis. Shorter latency between HZ and neurologic symptoms was the only factor associated with an unfavorable course (death or sequelae) (odds ratio, 0.82; 95% confidence interval, 0.71-0.95). In conclusion, the clinical spectrum of neurological complications in VZV reactivation is wide. Mortality was low and sequelae were mild. The presence of IS may play a role on the severity of neurological symptoms, and a shorter time between HZ and the onset of neurological symptoms appears to be a negative prognostic factor.
免疫抑制患者发生带状疱疹（HZ）的风险更高，且他们常出现神经系统并发症。然而，免疫抑制（IS）对水痘-带状疱疹病毒（VZV）再激活所致神经系统并发症的严重程度和预后的影响尚不清楚。我们对2004年至2019年间在我院就诊的因VZV再激活而出现神经系统并发症的患者进行了回顾性研究。我们旨在评估临床谱、潜在的预后因素以及免疫状态对神经症状严重程度的影响。共纳入98例患者（40%有免疫抑制）。55例患者（56%）有颅神经病变，其中包括拉姆齐-亨特综合征（36例患者）和颅多发性神经炎（23例患者）。21例患者发生脑炎（21%）。其他诊断包括神经根病、脑膜炎、血管炎或脊髓炎（分别为15例、10例、6例和4例患者）。死亡率较低（3%）。随访时，24%的患者有持续症状，尽管通常较轻。免疫抑制与严重程度相关（定义为改良Rankin量表评分大于2）（比值比，4.23；95%置信区间，1.74-10.27），但与预后无关。HZ与神经症状之间较短的潜伏期是唯一与不良病程（死亡或后遗症）相关的因素（比值比，0.82；95%置信区间，0.71-0.95）。总之，VZV再激活所致神经系统并发症的临床谱较广。死亡率低，后遗症较轻。免疫抑制的存在可能对神经症状的严重程度有影响，HZ与神经症状出现之间较短的时间似乎是一个不良预后因素。
