Incidence and Risk Factors for Varicella-Zoster Virus-Associated Central Nervous System Infections: A Nationwide
Tobias Tyrberg1,2, Lars Hagberg1,2, Staffan Nilsson3
1Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Journal of Medical Virology
|January 26, 2025
Summary
Varicella-zoster virus (VZV) causes central nervous system (CNS) infections in adults, particularly the elderly with weakened immunity or other health issues. HIV and hematological cancers are key risk factors.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Varicella-zoster virus (VZV) central nervous system (CNS) infections are not fully understood.
- Identifying incidence and risk factors is crucial for managing VZV-associated CNS disease.
Purpose of the Study:
- To investigate the incidence and risk factors for VZV-associated CNS infections in adults.
- To analyze different VZV-associated CNS infection manifestations and their associated risks.
Main Methods:
- Retrospective study using Swedish national and regional patient registers (2010-2019).
- Inclusion of 1488 adult VZV-CNS infection cases, matched with controls.
- Multivariable logistic regression analysis to identify risk factors.
Main Results:
- Overall incidence of VZV-associated CNS infection was 1.92/100,000 person-years, increasing over time.
- Meningitis (45%), encephalitis (38%), and Ramsay Hunt syndrome (17%) were common manifestations.
- Older age (>70 years) and conditions like HIV, hematological cancer, immunosuppression, COPD, diabetes, and stroke were significant risk factors.
Conclusions:
- VZV is a significant cause of adult viral CNS infections.
- Elderly individuals with immunosuppressive conditions or comorbidities face the highest risk.
- HIV, hematological cancer, and specific immunosuppressive treatments are the strongest identified risk factors.
