title: Incidence of varicella zoster virus infections of the central nervous system in the elderly: a large tertiary hospital-based series (2007-2014).
abstract: The aim of the study was to describe the clinical and epidemiological characteristics of the central nervous system (CNS) infection by varicella zoster virus (VZV) in patients older than 65 years in a tertiary community hospital. We retrospectively analysed the results of cerebrospinal fluid (CSF) testing in patients older than 65 years between 2007 and 2014 with clinically suspected VZV infection with CNS involvement. Patients whose CSF samples were positive for VZV DNA were included, as were those with negative results who simultaneously presented herpes zoster and CSF or magnetic resonance imaging findings suggestive of CNS infection, and in whom other possible aetiologies had been ruled out. The study included 280 patients. The disease was considered to be caused by a VZV infection in 32 patients (11.4%), of which 23 cases were virologically confirmed (detection of VZV DNA in CSF). The most frequent diagnosis of the patients with VZV CNS infection was encephalitis (83.3%), followed by meningitis (13.3%) and cerebellitis (3.3%). The mean annual incidence of VZV CNS infection was 3.0 cases per 100,000 inhabitants. VZV was the most common cause of encephalitis and viral meningitis, ahead of herpes simplex virus (n = 9). At the time of discharge, 12 (40%) patients showed neurological sequelae. Five patients (20%) died during hospitalization, all with encephalitis. Patients with a fatal outcome had significantly higher median age and longer delay before initiating acyclovir. In conclusion, VZV was the first cause of encephalitis in our elderly population. Despite acyclovir treatment, there was a high rate of case fatality and sequelae at discharge.
authors.affiliation: Department of Neurology, Hospital Universitario Donostia, 20014, San Sebastian, Spain. m_arruti@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Arruti
authors.affiliation: Department of Microbiology, Hospital Universitario Donostia, Biodonostia Health Research Institute, San Sebastián, Spain.
authors.forename: L D
authors.initials: LD
authors.lastname: Piñeiro
authors.affiliation: Department of Microbiology, Hospital Universitario Donostia, Biodonostia Health Research Institute, San Sebastián, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: Salicio
authors.affiliation: Department of Microbiology, Hospital Universitario Donostia, Biodonostia Health Research Institute, San Sebastián, Spain.|Biomedical Research Centre Network for Respiratory Diseases (CIBERES), Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Cilla
authors.affiliation: Infectious Diseases Unit, Hospital Universitario Donostia, San Sebastián, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Goenaga
authors.affiliation: Department of Neurology, Hospital Universitario Donostia, 20014, San Sebastian, Spain.|Neuroscience Research Area, Biodonostia Health Research Institute, San Sebastián, Spain.|CIBERNED (Centro de Investigación Biomédica en Red para Enfermedades Neurodegenerativas), Instituto Carlos III, Ministerio de Economía y Competitividad, Madrid, Spain.|Department of Neuroscience, University of Basque Country, UPV-EHU, San Sebastián, Spain.
authors.forename: A
authors.initials: A
authors.lastname: López de Munain
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D002490:Central Nervous System / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000134:cerebrospinal fluid*; D020804:Encephalitis, Varicella Zoster / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000472:pathogenicity* / Q000502:physiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008587:Meningitis, Viral / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D000073618:Varicella Zoster Virus Infection / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir
keywords: Central nervous system infection; Encephalitis; Epidemiology; Herpes simplex virus; Varicella zoster virus