Clinical characteristics of varicella-zoster virus central nervous system infection in 108 unimmunocompromised patients

Xiaojiao Ci Jihong Zhang ^* Jie Lu ^* Xinyang Qi ^* Yifang Ma ^* Weiguo Liu ^* Jingping Shi ^*

• Department of Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu Province, China

BackgroundVaricella-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. MethodsThis retrospective study was conducted in the Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, China. CSF-mNGS revealed a positive result for VZV, leading to a clinical diagnosis of VZV central nervous system infection. We analyzed the patients’ age, gender, clinical manifestations, blood routine, ESR, CSF examination, MRI, electroencephalogram , and ADL scale scores on the day of admission and one month post-discharge.ResultsThe 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±0.48*109/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±2.38mmH2O; the average CSF WBC count was 196.60±3.98*10^6/l, the average CSF protein was 1.35±0.03g/l, the average CSF glucose was 3.41±0.03mmol/l, the average CSF chloride was 116.62±0.15mmol/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. Conclusion: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.