1423. Clinical Features, Outcomes, and Cerebrospinal Fluid Findings in Patients with Central Nervous System (CNS) Infections Caused by Varicella-Zoster Virus: Comparison with Enterovirus CNS Infections
Session: Poster Abstract Session: CNS Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Varicella-zoster virus (VZV) is known to be associated central nervous system (CNS) infections in adults. However, the clinical characteristics of VZV CNS infections are still not well characterized. The objective of this study is to compare the clinical manifestations, outcomes, and cerebrospinal fluid (CSF) findings in patients with VZV CNS infections with those in patients with enterovirus (EV) CNS infections.

Methods: This retrospective cohort study was performed at a 2,700-bed tertiary care hospital. Using a clinical microbiology computerized database, we identified all of the adults with positive PCR results for VZV or EV in CSF between January 1999 and February 2013. Data regarding patient demographics, clinical manifestations, outcomes, and laboratory data were reviewed.

Results: Thirty-eight patients were VZV PCR-positive and 68 were EV PCR-positive. Compared with the EV group, the median age was higher in the VZV group (VZV, 35 years [IQR, 26 – 62] vs. EV, 31 years [IQR, 24 – 34]; P = 0.02). Aseptic meningitis was the most common clinical diagnosis in both patient groups (VZV 76.9% [29/38] and EV 94.1% [64/68]; P = 0.01). Encephalitis were more commonly associated with the VZV group (VZV, 23.7% [9/38] vs. EV, 4.4% [3/68]; P = 0.01). Simultaneous cutaneous zosters were observed in one-third of the VZV group (31.6%, 12/38). The median length of the hospital stay was significantly longer in the VZV group (VZV, 10 days vs. EV, 4 days; P < 0.001). However, in-hospital mortality (VZV, 0% [0/38] vs. EV, 1.5% [1/68], P = 1.000) and long-term neurologic sequelae were rare in both patient groups (VZV, 2.6% [1/38] vs. EV, 0% [0/68], P = 1.000). Although the median total CSF leukocyte counts did not differ significantly in the two patient groups (VZV, 150/mm3 vs. EV, 105/mm3), the median lymphocyte percentage (VZV, 81% vs. EV, 36%; P < 0.001) and the CSF protein level (VZV, 100 mg/dL vs. EV, 46 mg/dL; P< 0.001) were higher in the VZV group.

Conclusion: Patients with VZV CNS infection were older than patients with EV CNS infection and they developed encephalitis more often. CSF profiles showed a higher lymphocyte percentage and protein level with VZV CNS infection, however, both VZV and EV CNS infections were associated with an excellent long-term prognosis.

Hyo-Lim Hong, MD1, Ju-Young Lee, MD1, Tark Kim, MD1, So-Youn Park, MD1, Hyun Jung Park, MD1, Song Mi Moon, MD2, Yong Pil Chong, MD, PhD1, Sung-Han Kim, MD1, Sang-Oh Lee, MD1, Yang Soo Kim, MD1, Jun Hee Woo, MD, PhD1 and Sang-Ho Choi, MD1, (1)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (2)Department of Infectious Disease, Gachon University Gil Hospital, Incheon, South Korea

Disclosures:

H. L. Hong, None

J. Y. Lee, None

T. Kim, None

S. Y. Park, None

H. J. Park, None

S. M. Moon, None

Y. P. Chong, None

S. H. Kim, None

S. O. Lee, None

Y. S. Kim, None

J. H. Woo, None

S. H. Choi, None

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