Laura Krogh Herlin1, Kristoffer Skaalum Hansen1, Jacob Bodilsen2, Lykke Larsen3,4,5, Christian Brandt6, Christian Østergaard Andersen7, Birgitte Rønde Hansen8, Hans Rudolf Lüttichau9, Jannik Helweg-Larsen10, Lothar Wiese11, Merete Storgaard1, Henrik Nielsen2,12, Trine H Mogensen1,13,14. 1. Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark. 2. Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark. 3. Department of Infectious Diseases, Odense University Hospital, Odense, Denmark. 4. Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark. 5. University of Southern Denmark, Odense, Denmark. 6. Department of Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark. 7. Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark. 8. Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark. 9. Department of Infectious Diseases, Herlev Hospital, Copenhagen, Denmark. 10. Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark. 11. Department of Infectious Diseases, Sjælland University Hospital, Roskilde, Denmark. 12. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 13. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 14. Department of Biomedicine, Aarhus University, Aarhus, Denmark.
Abstract
BACKGROUND: Knowledge of the epidemiology and clinical characteristics of varicella zoster virus (VZV) encephalitis remains limited. METHODS: Nationwide prospective cohort study of adults treated for microbiologically confirmed VZV encephalitis at Danish departments of infectious diseases from 2015 to 2019. Modified Poisson regression analysis was used to compute adjusted relative risks (RRs) of unfavorable outcome. RESULTS: We identified 92 adults (49% female) with VZV encephalitis, yielding an incidence of 5.3/1 000 000 per year (95% CI, 4.2-6.6). Median age was 75 years (IQR, 67-83) and immunocompromising conditions were frequent (39%). Predominant symptoms were confusion (76%), headache (56%), nausea (45%), gait disturbance (42%), and personality changes (41%). Cranial imaging showed cerebral vasculitis (including infarction and hemorrhage) in 14 (16%) patients and encephalitic abnormalities in 11 (13%) with predilection for the brainstem and deep brain structures. Intravenous acyclovir treatment was initiated a median (IQR) of 13.4 hours (5.2-46.3) since admission, while cranial imaging and lumbar puncture were performed after 6.3 hours (2.5-31.0) and 18.5 hours (4.9-42.0). In-hospital, 1-month, and 3-month mortalities were 4%, 9%, and 11%, respectively. Unfavorable outcome (Glasgow Outcome Score of 1-4) was found in 69% at discharge, with age (adjusted RR [aRR], 1.02; 95% CI, 1.01-1.03), vasculitis (aRR, 1.38; 95% CI, 1.02-1.86), and Glasgow Coma Scale (GCS) <15 (aRR, 1.32; 95% CI, 1.01-1.73) identified as independent risk factors. CONCLUSIONS: VZV encephalitis occurs primarily in elderly or immunocompromised patients with a higher incidence than previously estimated. The diagnosis is often delayed; risk factors for unfavorable outcome are age, cerebral vasculitis, and GCS <15.
BACKGROUND: Knowledge of the epidemiology and clinical characteristics of varicella zoster virus (VZV) encephalitis remains limited. METHODS: Nationwide prospective cohort study of adults treated for microbiologically confirmed VZV encephalitis at Danish departments of infectious diseases from 2015 to 2019. Modified Poisson regression analysis was used to compute adjusted relative risks (RRs) of unfavorable outcome. RESULTS: We identified 92 adults (49% female) with VZV encephalitis, yielding an incidence of 5.3/1 000 000 per year (95% CI, 4.2-6.6). Median age was 75 years (IQR, 67-83) and immunocompromising conditions were frequent (39%). Predominant symptoms were confusion (76%), headache (56%), nausea (45%), gait disturbance (42%), and personality changes (41%). Cranial imaging showed cerebral vasculitis (including infarction and hemorrhage) in 14 (16%) patients and encephalitic abnormalities in 11 (13%) with predilection for the brainstem and deep brain structures. Intravenous acyclovir treatment was initiated a median (IQR) of 13.4 hours (5.2-46.3) since admission, while cranial imaging and lumbar puncture were performed after 6.3 hours (2.5-31.0) and 18.5 hours (4.9-42.0). In-hospital, 1-month, and 3-month mortalities were 4%, 9%, and 11%, respectively. Unfavorable outcome (Glasgow Outcome Score of 1-4) was found in 69% at discharge, with age (adjusted RR [aRR], 1.02; 95% CI, 1.01-1.03), vasculitis (aRR, 1.38; 95% CI, 1.02-1.86), and Glasgow Coma Scale (GCS) <15 (aRR, 1.32; 95% CI, 1.01-1.73) identified as independent risk factors. CONCLUSIONS:VZV encephalitis occurs primarily in elderly or immunocompromised patients with a higher incidence than previously estimated. The diagnosis is often delayed; risk factors for unfavorable outcome are age, cerebral vasculitis, and GCS <15.
Authors: Paraskevi C Fragkou; Charalampos D Moschopoulos; Emmanouil Karofylakis; Theodoros Kelesidis; Sotirios Tsiodras Journal: Front Med (Lausanne) Date: 2021-02-23