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Characteristics and outcome of varicella-zoster virus central nervous system infections in adults

European Journal of Clinical Microbiology & Infectious Diseases volume 40, pages 2437–2442 (2021)Cite this article

Abstract

We conducted an observational retrospective study of all adults hospitalized for documented varicella-zoster virus (VZV) meningitis or encephalitis during years 2000–2015 in one referral centre. Thirty-six patients (21 males, 15 females) were included, with meningitis (n = 21), or meningoencephalitis (n = 15). Median age was 51 years [interquartile range, 35–76], and 6 patients (17%) were immunocompromised. Aciclovir was started in 32 patients (89%), with a median dose of 11 mg/kg/8 h [10–15]. No patient died, but 12 (33%) had neurological sequelae at discharge. Age was the only variable associated with adverse outcome (OR 1.98 [1.17–3.35] per 10-year increment, P = 0.011).

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References

  1. Boucher A, Herrmann JL, Morand P, Buzelé R, Crabol Y, Stahl JP et al (2017) Epidemiology of infectious encephalitis causes in 2016. Med Mal Infect 47:221–235. https://doi.org/10.1016/j.medmal.2017.02.003

    CAS  Article  PubMed  Google Scholar 

  2. Grahn A, Studahl M (2015) Varicella-zoster virus infections of the central nervous system–prognosis, diagnostics and treatment. J Inf Secur 71:281–293. https://doi.org/10.1016/j.jinf.2015.06.004

    Article  Google Scholar 

  3. Mailles A, Stahl J-P (2009) Steering Committee and Investigators Group. Infectious encephalitis in France in 2007: a national prospective study. Clin Infect Dis 49:1838–1847. https://doi.org/10.1086/648419

    Article  PubMed  Google Scholar 

  4. Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D et al (2010) Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis 10:835–844. https://doi.org/10.1016/S1473-3099(10)70222-X

    Article  PubMed  Google Scholar 

  5. Le Maréchal M, Mailles A, Seigneurin A, Tattevin P, Stahl J-P, Épaulard O (2020) A prospective cohort study to identify clinical, biological and imaging features that predict etiology of acute encephalitis. Clin Infect Dis 20. https://doi.org/10.1093/cid/ciaa598

  6. Stahl JP, Azouvi P, Bruneel F, De Broucker T, Duval X, Fantin B et al (2017) Guidelines on the management of infectious encephalitis in adults. Med Mal Infect 47:179–194. https://doi.org/10.1016/j.medmal.2017.01.005

    CAS  Article  PubMed  Google Scholar 

  7. Chemaly RF, Hill JA, Voigt S, Peggs KS (2019) In vitro comparison of currently available and investigational antiviral agents against pathogenic human double-stranded DNA viruses: a systematic literature review. Antivir Res 163:50–58. https://doi.org/10.1016/j.antiviral.2019.01.008

    CAS  Article  PubMed  Google Scholar 

  8. Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A et al (2013) Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis 57:1114–1128. https://doi.org/10.1093/cid/cit458

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. Reizine F, Pronier C, Lepart C, Grolhier C, Revest M, Thibault V et al (2020) Biphasic evolution of varicella-zoster virus meningoencephalitis: diagnostic challenges. Med Mal Infect 50:87–89. https://doi.org/10.1016/j.medmal.2019.10.016

    CAS  Article  PubMed  Google Scholar 

  10. Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL et al (2008) The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 47:303–327. https://doi.org/10.1086/589747

    CAS  Article  PubMed  Google Scholar 

  11. Klassen TP, Hartling L, Wiebe N, Belseck EM (2005) Acyclovir for treating varicella in otherwise healthy children and adolescents. Cochrane Database Syst Rev 19:CD002980. https://doi.org/10.1002/14651858.CD002980.pub3

    Article  Google Scholar 

  12. Whitley RJ, Gnann JW, Hinthorn D, Liu C, Pollard RB, Hayden F et al (1992) Disseminated herpes zoster in the immunocompromised host: a comparative trial of acyclovir and vidarabine. The NIAID Collaborative Antiviral Study Group. J Infect Dis 165:450–455. https://doi.org/10.1093/infdis/165.3.450

    CAS  Article  PubMed  Google Scholar 

  13. Herlin LK, Hansen KS, Bodilsen J, Larsen L, Brandt C, Andersen CØ et al (2020) Varicella zoster virus encephalitis in Denmark from 2015 to 2019-a nationwide prospective cohort study. Clin Infect Dis 27. https://doi.org/10.1093/cid/ciaa185

  14. Parkes-Smith J, Chaudhuri A (2020) Varicella zoster virus: an under-recognised cause of central nervous system infections? Intern Med J 8. https://doi.org/10.1111/imj.15048

  15. Pollak L, Dovrat S, Book M, Mendelson E, Weinberger M (2012) Varicella zoster vs. herpes simplex meningoencephalitis in the PCR era. A single center study. J Neurol Sci 314:29–36. https://doi.org/10.1016/j.jns.2011.11.004

    Article  PubMed  Google Scholar 

  16. George BP, Schneider EB, Venkatesan A (2014) Encephalitis hospitalization rates and inpatient mortality in the United States, 2000-2010. PLoS One 9:e104169. https://doi.org/10.1371/journal.pone.0104169

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Erdem H, Cag Y, Ozturk-Engin D, Defres S, Kaya S, Larsen L et al (2015) Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis. Antimicrob Agents Chemother 59:3084–3089. https://doi.org/10.1128/AAC.05016-14

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Mailles A, De Broucker T, Costanzo P, Martinez-Almoyna L, Vaillant V, Stahl J-P et al (2012) Long-term outcome of patients presenting with acute infectious encephalitis of various causes in France. Clin Infect Dis 54:1455–1464. https://doi.org/10.1093/cid/cis226

    Article  PubMed  Google Scholar 

  19. Singh TD, Fugate JE, Hocker S, Wijdicks EFM, Aksamit AJ, Rabinstein AA (2016) Predictors of outcome in HSV encephalitis. J Neurol 263:277–289. https://doi.org/10.1007/s00415-015-7960-8

    CAS  Article  PubMed  Google Scholar 

  20. Ryan L, Heed A, Foster J, Valappil M, Schmid ML, Duncan CJA (2018) Acute kidney injury (AKI) associated with intravenous aciclovir in adults: incidence and risk factors in clinical practice. Int J Infect Dis 74:97–99. https://doi.org/10.1016/j.ijid.2018.07.002

    CAS  Article  PubMed  Google Scholar 

  21. Martinot M, Klein A, Demesmay K, Groza M, Mohseni-Zadeh M, Tebacher-Alt M et al (2019) Acute renal failure related to high doses of acyclovir (15 mg/kg/8 h) during treatment of varicella zoster virus encephalitis. Antivir Ther (Lond) 24:309–312. https://doi.org/10.3851/IMP3313

    Article  Google Scholar 

  22. Sawyer MH, Webb DE, Balow JE, Straus SE (1988) Acyclovir-induced renal failure. Clinical course and histology. Am J Med 84:1067–1071. https://doi.org/10.1016/0002-9343(88)90313-0

    CAS  Article  PubMed  Google Scholar 

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Author notes

  1. A. Le Bot and A. Ballerie contributed equally to this work.

Authors and Affiliations

  1. Infectious Diseases and Medical Intensive Care Unit, Pontchaillou University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex 9, France

    A. Le Bot, F. Bénézit, F. Reizine, M. Revest, Y. Le Tulzo & Pierre Tattevin

  2. Internal Medicine and Clinical Immunology, Pontchaillou University Hospital, Rennes, France

    A. Ballerie & P. Jégo

  3. Virology, Pontchaillou University Hospital, Rennes, France

    C. Pronier

  4. Radiology, Pontchaillou University Hospital, Rennes, France

    M. Tas

  5. Intensive Care Unit, Yves Le Foll Hospital, St Brieuc, France

    P. Fillâtre

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  1. A. Le Bot
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  11. Pierre Tattevin
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Correspondence to Pierre Tattevin.

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The study was approved by the Ethic Committee of Rennes University Hospital (no. 19.98).

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Le Bot, A., Ballerie, A., Pronier, C. et al. Characteristics and outcome of varicella-zoster virus central nervous system infections in adults. Eur J Clin Microbiol Infect Dis 40, 2437–2442 (2021). https://doi.org/10.1007/s10096-021-04245-y

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Keywords

  • Varicella-zoster virus
  • Encephalitis
  • Meningitis
  • Prognosis