Ci Xiaojiao, Zhang Jihong, Lu Jie, Qi Xinyang, Ma Yifang, Liu Weiguo, Shi Jingping
Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
Front Neurol. 2025 Feb 24;16:1554954. doi: 10.3389/fneur.2025.1554954. eCollection 2025.
Varicella-zoster virus (VZV) central nervous system infection is typically observed in immunocompromised patients, and there is a lack of studies involving large samples of non-immunocompromised individuals. In this study, we retrospectively analyzed 108 non-immunocompromised patients diagnosed with VZV central nervous system infection.
This retrospective study was conducted in the Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, China. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) revealed a positive result for VZV with a sequence number greater than 3, leading to a clinical diagnosis of VZV central nervous system infection. We analyzed the patients' age, gender, clinical manifestations, blood routine, erythrocyte sedimentation rate (ESR), CSF examination, magnetic resonance imaging (MRI), electroencephalogram (EEG), and Activities of Daily Living (ADL) scale scores (Barthel Index) on the day of admission and 3 month post-discharge.
The study involved 108 patients, average age was 47.58 ± 2.91 years old (16 to 80), 33 were female (30.60%) and 75 were male (69.40%). Clinical manifestations were fever (63.9%), headache (88.9%), nausea (50%), vomiting (27.8%), fatigue (50%), dizziness (25.0%), herpes zoster (47.2%), chickenpox (0.9%), peripheral facial paralysis (19.4%), encephalopathy (5.6%), and myelitis (2.8%). The average white blood cell (WBC) count was 7.40 ± 0.4810/l, the average CRP was 6.58 ± 0.69 mg/L, and the average ESR was 7.79 ± 0.53 mm/h. 28.1% of patients exhibited elevated lumbar puncture pressure, the average lumbar puncture pressure was 155.41 ± 2.38 mmHO; the average CSF WBC count was 196.60 ± 3.9810^6/l, the average CSF protein was 1.35 ± 0.03 g/L, the average CSF glucose was 3.41 ± 0.03 mmoL/L, the average CSF chloride was 116.62 ± 0.15 mmoL/L, the average CSF IgG index was 0.66 ± 0.01, the average mNGS examination of VZV sequence count was 626.25 ± 5402.17. Head MRI scans revealed no new lesions; three patients' spinal cord MRI displayed short-segment, non-transverse, and non-continuous patchy long T1 and long T2 signals in the thoracic or cervical spinal cord. On the first day of admission, 41.7% of the patients achieved ADL score of 100 points, 19.4% scored between 41 and 99 points, and 38.9% of the patients scored less than 40 points. All patients received intravenous infusions of acyclovir with low-dose corticosteroids. An outpatient review conducted 3 months after discharge indicated 98.15% of the patients recovered well without any sequelae.
VZV encephalitis in immunocompetent individuals typically presents with mild clinical symptoms and has a favorable prognosis. VZV should be considered the common pathogen in the management of patients without immunocompeted condition with encephalitis.
水痘带状疱疹病毒（VZV）中枢神经系统感染通常见于免疫功能低下的患者，而缺乏针对大量非免疫功能低下个体的研究。在本研究中，我们回顾性分析了108例被诊断为VZV中枢神经系统感染的非免疫功能低下患者。
本回顾性研究在中国南京医科大学附属南京脑科医院神经内科进行。脑脊液（CSF）的宏基因组下一代测序（mNGS）显示VZV结果为阳性，序列数大于3，从而临床诊断为VZV中枢神经系统感染。我们分析了患者入院当天及出院后3个月的年龄、性别、临床表现、血常规、红细胞沉降率（ESR）、脑脊液检查、磁共振成像（MRI）、脑电图（EEG）以及日常生活活动（ADL）量表评分（Barthel指数）。
该研究纳入108例患者，平均年龄为47.58±2.91岁（16至80岁），女性33例（30.60%），男性75例（69.40%）。临床表现为发热（63.9%）、头痛（88.9%）、恶心（50%）、呕吐（27.8%）、乏力（50%）、头晕（25.0%）、带状疱疹（47.2%）、水痘（0.9%）、周围性面瘫（19.4%）、脑病（5.6%）和脊髓炎（2.8%）。平均白细胞（WBC）计数为7.40±0.48×10⁹/L，平均C反应蛋白（CRP）为6.58±0.69mg/L，平均ESR为7.79±0.53mm/h。28.1%的患者腰穿压力升高，平均腰穿压力为155.41±2.38mmH₂O；平均脑脊液白细胞计数为196.60±3.98×10⁶/L，平均脑脊液蛋白为1.35±0.03g/L，平均脑脊液葡萄糖为3.41±0.03mmol/L，平均脑脊液氯化物为116.62±0.15mmol/L，平均脑脊液IgG指数为0.66±0.01，平均mNGS检查的VZV序列数为626.25±5402.17。头部MRI扫描未发现新病灶；3例患者的脊髓MRI显示胸段或颈段脊髓有短节段、非横贯、非连续的斑片状长T1和长T2信号。入院第一天，41.7%的患者ADL评分为100分，19.4%的患者评分在41至99分之间，38.9%的患者评分低于40分。所有患者均接受了静脉输注阿昔洛韦及低剂量糖皮质激素治疗。出院后3个月的门诊复查显示98.15%的患者恢复良好，无任何后遗症。
免疫功能正常个体的VZV脑炎通常表现为轻度临床症状，预后良好。在管理无免疫功能低下情况的脑炎患者时，应将VZV视为常见病原体。
