Yakovenko Viktoria, Ciobotaro Pnina, Bardenstein Rita, Zusev Margalit, Zimhony Oren
Infection Diseases Department, Kaplan Medical Center, Rehovot, Israel.
Clinical Microbiology Laboratory, Kaplan Medical Center, Rehovot, Israel.
Can J Infect Dis Med Microbiol. 2024 Nov 13;2024:6664417. doi: 10.1155/cjid/6664417. eCollection 2024.
We describe the proportion of VZV infection in central nervous system (CNS) infectious syndromes in a single Israeli medical center. An observational cohort study was conducted in Kaplan Medical Center (a secondary hospital, Israel) between July 1, 2014, and March 31, 2019. Included were adult patients (≥ 16 years old) with CNS infection with an aseptic CSF profile that were subjected to molecular tests for herpes viruses, HSV either 1 or 2, VZV, enteroviruses, and IgM for West Nile virus (WNV). Clinical presentation suggestive of CNS infection led to lumbar puncture and CSF analysis in 1500 patients yielding 178 cases with aseptic CSF profile. For 62/109 (55.9%) cases of meningitis, the etiology remained unknown, enterovirus accounted for 21 cases (18.9%), VZV for 16 (14.4%), and HSV 1 for 7 (6.3%). One case each of bacterial, fungal, and parainfluenza virus accounted for the other 3 cases. For 30/63 (47.6%) cases of encephalitis, the etiology remained unknown, HSV accounted for 11 cases (17.5%), VZV for 8 (12.7%), and WNV for 10 (15.9%); in two cases, enterovirus was identified and one case of influenza A and one of mycoplasma, accounted for the rest. In six patients with myelitis VZV was identified in 4 (66.7%). Notably, a typical herpetic rash was identified in only 11/28 (39.28%) of cases of VZV CNS infection. VZV is a significant cause of viral CNS infections. In the majority of patients with neurologic syndrome and evident VZV there is no association with a typical herpetic rash. These results apply to Israeli population and likely to other populations with similar background of VZV past infections.
我们描述了以色列一家医疗中心中枢神经系统（CNS）感染综合征中水痘带状疱疹病毒（VZV）感染的比例。2014年7月1日至2019年3月31日期间，在卡普兰医疗中心（以色列一家二级医院）进行了一项观察性队列研究。纳入的是患有中枢神经系统感染且脑脊液无菌特征的成年患者（≥16岁），这些患者接受了针对疱疹病毒、1型或2型单纯疱疹病毒（HSV）、VZV、肠道病毒以及西尼罗河病毒（WNV）IgM的分子检测。提示中枢神经系统感染的临床表现导致1500例患者进行了腰椎穿刺和脑脊液分析，其中178例患者脑脊液无菌特征。在62/109（55.9%）例脑膜炎病例中，病因仍不明，肠道病毒占21例（18.9%），VZV占16例（14.4%），HSV - 1占7例（6.3%）。细菌、真菌和副流感病毒各1例占其余3例。在30/63（47.6%）例脑炎病例中，病因仍不明，HSV占11例（17.5%），VZV占8例（12.7%），WNV占10例（15.9%）；在2例中鉴定出肠道病毒，其余为1例甲型流感和1例支原体。在6例脊髓炎患者中，4例（66.7%）鉴定出VZV。值得注意的是，在VZV中枢神经系统感染病例中，仅11/28（39.28%）出现典型疱疹性皮疹。VZV是病毒性中枢神经系统感染的重要原因。在大多数患有神经综合征且VZV明显的患者中，与典型疱疹性皮疹无关联。这些结果适用于以色列人群，可能也适用于有类似VZV既往感染背景的其他人群。
