成人水痘-带状疱疹病毒相关颅内感染5例临床分析

doi:10.3969/j.issn.1004-583X.2024.02.010

摘要/Abstract

摘要：

目的探讨水痘-带状疱疹病毒(varicella zoster virus, VZV)相关颅内感染的临床特点,脑脊液及影像学表现,治疗及转归,为临床诊治提供参考。方法回顾性总结2019年4月至2023年4月临沂市人民医院神经内科收治的5例VZV患者的临床资料,对其临床表现、辅助检查、治疗及预后进行分析。结果 5例VZV相关颅内感染患者男性多于女性,年龄(53.6±10.9)岁,急性起病,均有前驱感染病史。临床表现均有头痛、发热和局灶神经功能障碍。影像学检查可无明显异常或脑实质受累,脑实质受累时病灶累及幕上及幕下,可合并出血。脑脊液检查表现为5例白细胞增高[(399.4±84.20)×10⁶/L],4例氯化物降低[(107.65±7.17) mmol/L],5例蛋白含量均明显升高[(2.85±1.33) g/L],4例脑脊液糖/血糖<0.6, (0.52±0.05)。5例患者均通过脑脊液宏基因组二代测序(metagenomics next-generation sequencing, mNGS)检查确诊。抗病毒治疗整体预后良好。结论 VZV颅内感染中老年起病,趋于年轻化。临床症状轻重取决于感染是否累及脑实质。脑脊液与结核性脑膜炎脑脊液表现类似。mNGS检测可提高鉴别敏感性、准确性。及早对因对症治疗大多数患者预后相对良好。

关键词: 水痘-带状疱疹病毒感染, 宏基因组二代测序, 结核性脑膜炎, 颅内感染, 中枢神经系统, 成人

Abstract:

Objective To investigate the clinical features, cerebrospinal fluid (CSF) examination, imaging findings, treatment and outcome of intracranial infection of varicella zoster virus (VZV), thus providing reference for clinical diagnosis and treatment. Methods Clinical data of 5 VZV patients admitted to the Department of Neurology of Linyi People's Hospital from April 2019 to April 2023 was retrospectively summarized for the assessments of clinical manifestations, auxiliary examination, treatment and prognosis. Results Among the five patients with intracranial infection of VZV, males were more than females, with the mean age of (53.6±10.9) years, and acute onset and a history of preinfection. Clinical manifestations of all patients with intracranial infection of VZV were headache, fever and focal neurological deficits. Imaging findings showed there were no obvious abnormalities or involvement of brain parenchymal in the 5 patients. The lesion infiltrated supratentorially and infratentorially with hemorrhage when the infection involved the brain parenchyma. Metagenomic next-generation sequencing (mNGS) of CSF suggested that 5 cases of increased leukocytes (399.4±84.20)×10⁶/L, 4 cases of decreased chloride (107.65±7.17) mmol/L, 5 cases of significantly increased protein content (2.85±1.33) g/L, 4 cases of CSF/plasma glucose ratio <0.6, (0.52±0.05). Five patients were confirmed by mNGS of CSF. The prognosis of antiviral therapy was good. Conclusion The onset of intracranial infection of VZV is seen in middle-aged and elderly, with a younger trend. The severity of clinical symptoms depends on whether the infection involves the brain parenchyma. The CSF manifestations associated with intracranial infection of VZV were similar to those of tuberculous meningitis. The mNGS detection can improve the sensitivity and accuracy of the identification. The prognosis of most patients is relatively good with early treatment on the cause and symptoms.

Key words: varicella zoster virus infection, metagenomics next-generation sequencing, tuberculous meningitis, intracranial infection, central nervous system, adult

中图分类号:

R512.35

刘婉琦, 樊树芹, 庄瑞雪, 贺峰, 刘振川, 解忠祥. 成人水痘-带状疱疹病毒相关颅内感染5例临床分析[J]. 临床荟萃, 2024, 39(2): 149-154.

Liu Wanqi, Fan Shuqin, Zhuang Ruixue, He Feng, Liu Zhenchuan, Xie Zhongxiang. Intracranial infection of varicella zoster virus in adults: Clinical analysis of 5 cases[J]. Clinical Focus, 2024, 39(2): 149-154.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.02.010

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I2/149

图/表 7

参考文献 29

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评分	描述
0	完全无症状
1	尽管有症状,但无明显功能障碍,能完成所有日常工作和生活
2	轻度残疾,不能完成病前所有活动,但不需帮助能照料自己的日常事务
3	中度残疾,需部分帮助,但能独立行走
4	中重度残疾,不能独立行走,日常生活需别人帮助
5	重度残疾,卧床,二便失禁,日常生活完全依赖他人
6	死亡

评分	描述
0	完全无症状
1	尽管有症状,但无明显功能障碍,能完成所有日常工作和生活
2	轻度残疾,不能完成病前所有活动,但不需帮助能照料自己的日常事务
3	中度残疾,需部分帮助,但能独立行走
4	中重度残疾,不能独立行走,日常生活需别人帮助
5	重度残疾,卧床,二便失禁,日常生活完全依赖他人
6	死亡

一般临床资料	例1	例2	例3	例4	例5
性别	男	女	女	男	男
年龄(岁)	60	67	47	36	58
前驱感染	+	+	+	+	+
既往史	-	-	佝偻病史	-	-
居住环境	-	-	家中养猪、牛	-	家中养猪、牛

一般临床资料	例1	例2	例3	例4	例5
性别	男	女	女	男	男
年龄(岁)	60	67	47	36	58
前驱感染	+	+	+	+	+
既往史	-	-	佝偻病史	-	-
居住环境	-	-	家中养猪、牛	-	家中养猪、牛

临床表现	例1	例2	例3	例4	例5
发热最高体温	39.4℃	38.6℃	38.2℃	39.0℃	38.5℃
头痛	+	+	+	+	+
恶心、呕吐	-	+	-	+	+
颈部僵硬	+	+	+	+	+
皮肤带状疱疹	-	-	-	-	+
眼痛、眼睑下垂	+	-	-	-	-
精神状态改变	-	+	-	-	-
癫痫发作	-	-	+	-	-
视物模糊	-	-	-	+	-
肢体活动不灵	-	+	+	-	-