Varicella-zoster virus infection in adult central nervous system:seven cases reports and literature review
Objective To explore the clinical features and prognosis of varicella-zoster virus (VZV) infection in adult central nervous system. Methods Patients with VZV infection in central nervous system admitted to Beijing Friendship Hospital,Capital Medical University from July 2013 to April 2024 were selected,the general and clinical data of the patients were collected,the clinical features and prognosis were analyzed,and previous literatures were reviewed. Results A total of seven patients were selected,among which six were males and one was female. The onset age ranged from 35 to 94 years old,with an average age of 65.1 years. All the seven cases had acute or subacute onset with fever,four cases with consciousness disorders,five with positive meningeal irritation sign,four accoumpanied by limb paralysis,headache,dizziness,three accoumpanied by peripheral facial paralysis,and five accompanied by skin herpes. Cerebrospinal fluid pressure was 80～190mmH2O (1mmH2O=0.0098 kPa),WBC 14～1039 106/L,protein 40.38～444.43 mg/dl,glucose 2.34～6.01 mmol/L,and chloride 108.90～125.00 mmol/L. The number of VZV virus DNA sequences detected by cerebrospinal fluid metagenomic next-generation sequencing (mNGS) was 7～8869. Imaging findings showed that brainstem and cerebellum were involved in three cases,cervical spinal cord in one case,dura mater or spinal cord strengthened in three cases,accompanied by subdural effusion or hemorrhage in one case,and acute cerebral infarction in two cases. After treatment,one case died during hospitalization (four months after onset),and six cases got better and were discharged. A total of two cases died (1.5～10months after onset),and four cases got better (six to sixty-three months after onset). Previous literatures reported that adult patients with VZV infection in the central nervous system had severe illness,poor prognosis,decreased glucose levels in cerebrospinal fluid,and involvement of cranial or peripheral nerves or cerebrovascular vessels,but no case was reported of concurrent dural enhancement. Conclusions The age distribution of VZV infection in adult central nervous system is wide,and it can be seen from young people to the elderly. The protein and WBC of cerebrospinal fluid can significantly increased,glucose and chloride are decreased in some patients,similar to tuberculosis infection. When meninges and brain parenchyma are involved simultaneously,the condition is critical,and the prognosis of elderly individuals is poor. It is recommended that patients with suspected central nervous system infections undergo lumbar puncture and cerebrospinal fluid mNGS examination as early as possible to standardize the use of antiviral drugs after early diagnosis and treatment to improve the prognosis.
varicella-zoster virus (VZV)central nervous system infectionmetagenomic next-generation sequencing (mNGS)meninges
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万方数据
