Volume 30, Number 12—December 2024
Synopsis
Increase in Adult Patients with Varicella Zoster Virus–Related Central Nervous System Infections, Japan
, Sayuri Shima, Masaaki Matsunaga, Soichiro Ishimaru, Yuki Higashimoto, Yoshiki Kawamura, Kei Kozawa, Akiko Yoshikawa, Akihiro Ueda, Atsuhiko Ota, Hirohisa Watanabe, Tatsuro Mutoh, and Tetsushi Yoshikawa
Table
Comparison of background and clinical characteristics of VZV-positive patients during 2013–2018 and 2019–2022 in study of increase in adult patients with VZV-related central nervous system infections, Japan*
| Characteristic | Total, N = 62 | 2013–2018, n = 24 | 2019–2022, n = 38 | p value |
|---|---|---|---|---|
| Sex | ||||
| M | 34 (54.8) | 13 (54.2) | 21 (55.3) | 1.0000 |
| F |
28 (45.2) |
11 (45.8) |
17 (44.7) |
|
| Median age (IQR) |
70.5 (48.5–78) |
69.5 (46.5–78.5) |
70.5 (50.3–77.5) |
0.9079 |
| Underlying conditions | ||||
| Diabetes | 13 (21.0) | 7 (29.2) | 6 (15.8) | 0.2217 |
| Hypertension | 12 (19.0) | 6 (25.0) | 6 (15.8) | 0.5111 |
| Solid tumor/hematological malignancy | 12 (19.0) | 5 (20.8) | 7 (18.4) | 1.0000 |
| Others | 48 (77.4) | 18 (75.0) | 30 (78.9) | 0.7617 |
| None | 11 (17.7) | 4 (16.7) | 7 (18.4) | 1.0000 |
| Prednisolone treatment |
11 (17.7) |
2 (8.3) |
9 (23.7) |
0.1776 |
| Final diagnosis | ||||
| Meningitis | 45 (72.6) | 12 (50.0) | 33 (86.8) | 0.0029 |
| Encephalitis | 7 (11.3) | 6 (25.0) | 1 (2.6) | 0.0111 |
| Myelitis | 3 (4.8) | 1 (4.2) | 2 (5.3) | 1.0000 |
| Hunt syndrome | 4 (6.5) | 2 (8.3) | 2 (5.3) | 0.6371 |
| Herpes zoster† | 2 (3.2) | 2 (8.3) | 0 | 0.1460 |
| Peripheral neuritis |
1 (1.6) |
1 (4.2) |
0 |
0.3871 |
| Clinical symptoms | ||||
| Herpes zoster | 49 (79.0) | 22 (91.7) | 27 (71.1) | 0.0623 |
| Cervical nerve | 11/49 (22.4) | 7/22 (31.8) | 4/27 (14.8) | 0.1854 |
| Trigeminal nerve | 19/49 (38.8) | 9/22 (40.9) | 10/27 (37.0) | 1.0000 |
| Thoracic nerve | 13/49 (26.5) | 6/22 (27.3) | 7/27 (25.9) | 1.0000 |
| Lumbar nerve | 10/49 (20.4) | 3/22 (13.6) | 7/27 (25.9) | 0.4778 |
| Sacral nerve | 2/49 (4.1) | 0/22 (0.0) | 2/27 (7.4) | 0.4949 |
| Postherpetic neuralgia | 23 (37.1) | 10 (41.7) | 13 (34.2) | 0.7818 |
| Confusion |
14 (22.6) |
8 (33.3) |
6 (15.8) |
0.1287 |
| Laboratory data | ||||
| Pleocytosis | 60 (96.8) | 22 (91.7) | 38 (100.0) | 0.1460 |
| Median VZV DNA copy numbers (IQR) |
4.7 × 105 (5.7 × 104–2.3 × 106) |
8.2 × 105 (2.8 × 105 –5.7 × 106) |
4.2 × 105 (5.3 × 104–1.0 × 106) |
0.1255 |
| Imaging data | ||||
| Abnormal brain MRI finding | 9/50‡ (18.0) | 7/21 (33.3) | 2/29 (6.9) | 0.0253 |
| Abnormal EEG finding |
7/20§ (35.0) |
5/14 (35.7) |
2/6 (33.3) |
1.0000 |
| Treatment | ||||
| Intravenous acyclovir administration | 61 (98.4) | 24 (100.0) | 37 (97.4) | 1.0000 |
| Median duration, d (IQR) | 14 (10–15) | 14 (11.8–15.5) | 14 (10–14.6) | 0.6480 |
| Adjunctive prednisone |
10 (16.1) |
2 (8.3) |
8 (21.1) |
0.0750 |
| Prognosis | ||||
| Sequelae | 33 (53.2) | 14 (50.0) | 19 (50.0) | 0.4398 |
| Fatal | 1 (1.6) | 1 (4.2) | 0 | 0.3871 |
*Values are no. (%) except as indicated. EEG, electroencephalogram; IQR, interquartile range; MRI, magnetic resonance imaging; VZV, varicella zoster virus. †The classification of herpes zoster as the final diagnosis indicates that those patients were not categorized under any of the other diseases listed in this table; they are classified as having herpes zoster only. ‡Of 62 patients with VZV-related central nervous system infections, 50 underwent brain MRI. §Of 62 patients with VZV-related central nervous system infections, 20 underwent EEG.