Department of Neurology, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Neurology, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Republic of Korea.
Medicine (Baltimore). 2021 Nov 19;100(46):e27856. doi: 10.1097/MD.0000000000027856.
Three α-herpesviruses are known to be associated with central nervous system (CNS) infection; however, there are limited data on the incidence and clinical characteristics of α-herpesviruses CNS infections. This study aimed to assess the clinical manifestations, laboratory findings, and outcomes in patients with human herpes simplex virus 1 (HSV-1), human herpes simplex virus 2 (HSV-2), and varicella-zoster virus (VZV) CNS infections.We identified cases of HSV-1, HSV-2, and VZV CNS infections and reviewed their clinical and laboratory characteristics. The study population was drawn from patients with HSV-1, HSV-2, and VZV polymerase chain reaction positivity in cerebrospinal fluid (CSF) who visited Pusan National University Hospital between 2010 and 2018.During the 9-year study period, a total of 727 CSF samples were examined, with 72.2% (525/727) patients identified as having a CNS infection. Of 471 patients with aseptic meningitis and encephalitis, the causative virus was identified in 145 patients, and no virus was detected in 337 patients. A total of 15.2% (80/525) were diagnosed with one of the 3 herpesviruses as causative agents, 59 patients had meningitis, and 21 patients had encephalitis. Eleven patients with HSV-1, 27 patients with HSV-2, and 42 patients with VZV CNS infections were included. The distribution of cases by age showed different patterns depending on the type of herpesvirus infection. Compared with the HSV-1 group, the median age in the HSV-2 group was younger (HSV-1: 58 years; HSV-2: 38 years; P = .004), and patients with VZV infections showed a bimodal age distribution. Encephalitis was more common in the HSV-1 group, and HSV-1 infection was associated with a poor prognosis at discharge. CSF white blood cell counts were significantly lower in patients infected with HSV-1 (117 × 106 cells/L) than in patients infected with VZV (301 × 106 cells/L) (P = .008).These 3 herpesviruses are important causes of CNS infections regardless of immunologic status. HSV-1 infection was commonly associated with encephalitis and poor prognosis; HSV-2 and VZV CNS infections were associated with a low risk of mortality and neurological sequelae.
三种α疱疹病毒已知与中枢神经系统（CNS）感染有关；然而，关于α疱疹病毒 CNS 感染的发病率和临床特征的数据有限。本研究旨在评估人类单纯疱疹病毒 1（HSV-1）、人类单纯疱疹病毒 2（HSV-2）和水痘带状疱疹病毒（VZV）CNS 感染患者的临床表现、实验室结果和转归。我们确定了 HSV-1、HSV-2 和 VZV CNS 感染的病例，并回顾了他们的临床和实验室特征。该研究人群来自于 2010 年至 2018 年期间在釜山国立大学医院就诊的 HSV-1、HSV-2 和 VZV 聚合酶链反应阳性的 CSF 患者。在 9 年的研究期间，共检查了 727 份 CSF 样本，其中 72.2%（525/727）的患者被诊断为 CNS 感染。在 471 名患有无菌性脑膜炎和脑炎的患者中，有 145 名患者的病因病毒得到了鉴定，337 名患者未检测到病毒。共有 15.2%（80/525）被诊断为 3 种疱疹病毒之一为致病因子，59 名患者患有脑膜炎，21 名患者患有脑炎。共有 11 名 HSV-1 患者、27 名 HSV-2 患者和 42 名 VZV CNS 感染患者入组。根据疱疹病毒感染的类型，年龄分布情况不同。与 HSV-1 组相比，HSV-2 组的中位年龄较小（HSV-1：58 岁；HSV-2：38 岁；P=.004），而 VZV 感染者的年龄呈双峰分布。HSV-1 组更常见脑炎，HSV-1 感染与出院时预后不良相关。与感染 VZV 的患者相比（301×106 个细胞/L），感染 HSV-1 的患者 CSF 白细胞计数显著较低（117×106 个细胞/L）（P=.008）。这 3 种疱疹病毒是 CNS 感染的重要原因，无论免疫状态如何。HSV-1 感染常与脑炎和不良预后相关；HSV-2 和 VZV CNS 感染与死亡率和神经后遗症风险低相关。
