Liu Keh-Sen, Liu Po-Yu, Tseng Chien-Hao, Liu Chia-Wei, Huang Wei-Hsuan, Huang Hsien-Po, Li Chia-Ru, Yang Tzu-An, Wang Hsin-Hui, Yeh Ting-Kuang
Division of Infectious Diseases, Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Genomic Center for Infectious Diseases, Taichung Veterans General Hospital, Taichung, Taiwan; Ph.D. in Translational Medicine, National Chung Hsing University, Taichung, Taiwan; Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
Diagn Microbiol Infect Dis. 2025 Oct;113(2):116893. doi: 10.1016/j.diagmicrobio.2025.116893. Epub 2025 May 10.
Varicella zoster virus (VZV) can cause central nervous system (CNS) infections, including meningitis and meningoencephalitis. This study describes the clinical and laboratory characteristics of VZV CNS infections diagnosed by multiplex PCR, a diagnostic tool with increasing global availability.
This retrospective study was conducted at a tertiary hospital in Taiwan and included patients diagnosed with VZV meningitis or meningoencephalitis from May 2023 to May 2024. VZV DNA in cerebrospinal fluid was detected using multiplex PCR. Data were collected from electronic health records, and statistical analysis was performed using SPSS 20.0.
Fifteen patients were included, 7 with meningoencephalitis and 7 with meningitis. Shingles was present in 66.7 % of patients. Notably, 40 % of patients had no pleocytosis in cerebrospinal fluid. The median hospital stay was significantly longer for meningoencephalitis patients (25.8 days) compared to meningitis patients (11.9 days, p = 0.018).
This study highlights the prevalence of atypical presentations in VZV CNS infections, including cases without cutaneous manifestations and those lacking cerebrospinal fluid pleocytosis. The findings underscore the critical role of multiplex PCR in diagnosing VZV meningitis and meningoencephalitis, particularly in cases with atypical presentations. The study also reveals the more severe nature of meningoencephalitis, as evidenced by longer hospital stays. These results challenge traditional diagnostic approaches and emphasize the need for a high index of suspicion for VZV in all cases of suspected viral CNS infection, regardless of initial clinical or cerebrospinal fluid findings.
水痘带状疱疹病毒（VZV）可引起中枢神经系统（CNS）感染，包括脑膜炎和脑膜脑炎。本研究描述了通过多重PCR诊断的VZV中枢神经系统感染的临床和实验室特征，多重PCR是一种在全球范围内越来越容易获得的诊断工具。
本回顾性研究在台湾一家三级医院进行，纳入了2023年5月至2024年5月期间诊断为VZV脑膜炎或脑膜脑炎的患者。使用多重PCR检测脑脊液中的VZV DNA。数据从电子健康记录中收集，并使用SPSS 20.0进行统计分析。
共纳入15例患者，其中7例为脑膜脑炎，7例为脑膜炎。66.7%的患者出现带状疱疹。值得注意的是，40%的患者脑脊液中无细胞数增多。脑膜脑炎患者的中位住院时间（25.8天）明显长于脑膜炎患者（11.9天，p = 0.018）。
本研究强调了VZV中枢神经系统感染中非典型表现的普遍性，包括无皮肤表现和脑脊液无细胞数增多的病例。这些发现强调了多重PCR在诊断VZV脑膜炎和脑膜脑炎中的关键作用，特别是在非典型表现的病例中。该研究还揭示了脑膜脑炎更严重的性质，住院时间更长证明了这一点。这些结果挑战了传统的诊断方法，并强调在所有疑似病毒性中枢神经系统感染的病例中，无论最初的临床或脑脊液检查结果如何，都需要对VZV保持高度怀疑。
