Xie Shuhua, Yang Xuying, Xia Han, Lai Jinxing, Liu Qing, Lu Zhijuan, He Dehai, Liu Xianghong
Department of Neurology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, 341000, China.
Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, 100000, China.
Open Med (Wars). 2023 Jul 10;18(1):20230744. doi: 10.1515/med-2023-0744. eCollection 2023.
Clinical presentation of central nervous system (CNS) infections caused by varicella-zoster virus (VZV) is highly sophisticated, making identification challenging. We retrospectively reported 18 cases of VZV neurologic disease confirmed by metagenomic next-generation sequencing (mNGS). The detection rate of mNGS was higher than that of PCR assay (100 vs 66.7%, < 0.05) and serum IgM antibody (100 vs 68.8%, < 0.05) measurement. Of the 18 cases, five patients were diagnosed with acute meningitis, three with acute meningitis combined with facial neuritis, three with acute meningitis combined with polycranial neuritis, and the remaining seven with various clinical diagnoses. Typical clinical symptoms included headache (15), fever (9), and rash (11). Cranial or spinal MRI showed abnormalities in 12 patients, and 17 patients had obvious neurological symptoms. The predominant genotype of VZV in this study was genotype J (100%, 10/10). All patients were treated with acyclovir/penciclovir and dexamethasone, 16 recovered and 2 died. Our study highlights the good performance of mNGS in diagnosing CNS infection caused by VZV. It could provide additional diagnostic evidence in patients with diverse clinical spectrum and variable manifestations.
水痘带状疱疹病毒（VZV）引起的中枢神经系统（CNS）感染的临床表现非常复杂，难以识别。我们回顾性报告了18例经宏基因组下一代测序（mNGS）确诊的VZV神经系统疾病病例。mNGS的检测率高于PCR检测（100%对66.7%，P<0.05）和血清IgM抗体检测（100%对68.8%，P<0.05）。18例患者中，5例诊断为急性脑膜炎，3例为急性脑膜炎合并面神经炎，3例为急性脑膜炎合并多颅神经炎，其余7例有各种临床诊断。典型临床症状包括头痛（15例）、发热（9例）和皮疹（11例）。头颅或脊髓MRI显示12例患者有异常，17例患者有明显神经症状。本研究中VZV的主要基因型为J型（100%，10/10）。所有患者均接受阿昔洛韦/喷昔洛韦和地塞米松治疗，16例康复，2例死亡。我们的研究突出了mNGS在诊断VZV引起的CNS感染方面的良好性能。它可为临床谱多样、表现各异的患者提供额外的诊断依据。
