Alexakis Konstantinos, Ioannou Petros, Sourvinos George, Kofteridis Diamantis P
MD, Internal Medicine Department, University Hospital of Heraklion, Heraklion, PC 71110, Greece.
MD, MSc, PhD, Assistant Professor of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece.
Germs. 2024 Sep 30;14(3):267-276. doi: 10.18683/germs.2024.1437. eCollection 2024 Sep.
Central nervous system (CNS) infection due to the varicella zoster virus (VZV) can complicate the primary infection or the reactivation, leading to significant mortality and morbidity. This study aimed to describe the clinical, laboratory, and radiological characteristics of patients with confirmed VZV CNS infection in a tertiary hospital in Greece.
Data about patients hospitalized from January 2018 to September 2023 with CNS infection by VZV, confirmed by a syndromic polymerase chain reaction in the cerebrospinal fluid (CSF), were retrospectively collected and evaluated.
In total, 14 patients were recorded. The median age was 49 years, and 35.7% were male. Headache was present in 71.4%, a rash in 57.1%, and fevers, nausea or vomiting, and disorientation in 35.7%. The CSF showed lymphocytic pleocytosis in all patients. Brain magnetic resonance imaging was performed in 53.8%. Empirical antivirals were given in 69.2%, and intravenous acyclovir was given to all patients after identification of VZV in the CSF. Only 7.1% (1 patient) required intensive care unit admission, and 7.1% (1 patient) died. Patients presenting without a rash may be slightly younger, have a slightly lower Charlson comorbidity index, be more likely to present with photophobia or phonophobia, and have lower serum CRP.
Patients presenting with VZV CNS infection have lymphocytic pleocytosis in the CSF and usually have a favorable outcome with antiviral treatment. Those presenting without a rash may have a different overall clinical phenotype from those with a rash; however, this must be evaluated in larger studies in the future.
水痘带状疱疹病毒（VZV）引起的中枢神经系统（CNS）感染可使原发性感染或病毒再激活复杂化，导致显著的死亡率和发病率。本研究旨在描述希腊一家三级医院确诊为VZV中枢神经系统感染患者的临床、实验室和影像学特征。
回顾性收集并评估2018年1月至2023年9月因VZV中枢神经系统感染住院患者的数据，这些患者通过脑脊液（CSF）中的症状性聚合酶链反应确诊。
共记录14例患者。中位年龄为49岁，男性占35.7%。71.4%的患者出现头痛，57.1%出现皮疹，35.7%出现发热、恶心或呕吐以及定向障碍。所有患者的脑脊液均显示淋巴细胞增多。53.8%的患者进行了脑磁共振成像检查。69.2%的患者给予了经验性抗病毒治疗，脑脊液中发现VZV后，所有患者均接受了静脉注射阿昔洛韦治疗。只有7.1%（1例患者）需要入住重症监护病房，7.1%（1例患者）死亡。无皮疹的患者可能年龄稍小，Charlson合并症指数稍低，更易出现畏光或畏声，血清CRP水平较低。
出现VZV中枢神经系统感染的患者脑脊液中有淋巴细胞增多，抗病毒治疗通常预后良好。无皮疹的患者与有皮疹的患者可能具有不同的总体临床表型；然而，这一点必须在未来更大规模的研究中进行评估。
