Persistent Neurologic Sequelae Among Older Patients With Varicella-Zoster Virus CNS Infections

Computer illustration of a varicella zoster virus particle, the cause of chickenpox and shingles. Varicella zoster virus is also known as human herpes virus type 3 (HHV-3).
Investigators conducted an observational, retrospective study to assess variables associated with poor outcomes in patients with varicella-zoster virus infection with central nervous system involvement.

Researchers found age to be an independent predictor of persistent neurologic sequelae following varicella-zoster virus (VZV) central nervous system infection, according to the results of a retrospective observational study published in the European Journal of Clinical Microbiology and Infectious Diseases.

The investigators retrospectively reviewed clinical outcomes of patients (N=36) treated in the intensive care unit at the Rennes University Hospital in France between 2000 and 2015 for VZV-related meningitis or encephalitis.

Enrolled patients (58.3% men, median age 51 years, interquartile range [IQR], 35 to 76 years) had meningitis (58.3%) or meningoencephalitis (41.7%), and 16.6% had comorbid HIV. Patients with meningitis were significantly younger (P =.004), had fewer incidents of fevers (P =.04), and experienced confusion (P <.001). More reported experiencing headaches (P =.03), and they had higher cerebrospinal fluid lymphocyte percentage (P =.008). No patient had central focal neurologic signs (P <.001).

Most patients (88.9%) underwent treatment with intravenous acyclovir; median treatment duration was 5 days for patients with meningitis and 14 days for patients with meningoencephalitis (P <.001). Patients received high (15 mg/kg/8 h; 40%), median (10 mg/kg/8 h; 40%), or lower doses due to renal failure (20%). Acyclovir-related renal failure occurred among 19% of patients.

Creatinine increased a median of 118 (IQR, 50-219) μmol/L compared with baseline values.

No instances of inpatient mortality were reported. Outcomes for patients in the meningitis and meningoencephalitis cohorts were neurologic sequelae at discharge (23.8% vs 46.7%; P =.18), peripheral facial palsy (19.0% vs 6.7%; P =.38), and cognitive impairment (4.8% vs 20.0%; P =.29), respectively. Neurologic sequelae persisting at discharge was associated with increased age (per 10-year increment: odds ratio [OR], 2.09; 95% CI, 1.20-3.64; P =.009).

This study may have been limited by including patients who tested negative for VZV but who had compatible vesicular rash (meningitis: n=2; encephalitis: n=3).

These data indicate that VZV-related central nervous system infections were not associated with high mortality rates, perhaps as a result of early administration of high-dose acyclovir. Lingering neurologic sequelae was associated with older age of patients.


Le Bot A, Ballerie A, Pronier C, et al. Characteristics and outcome of varicella-zoster virus central nervous system infections in adults. Eur J Clin Microbiol Infect Dis. Published online April 28, 2021. doi:10.1007/s10096-021-04245-y