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