Varicella-zoster virus-associated central nervous system infection in immunocompromised vs. immunocompetent herpes zoster patients: a comparative study

Objectives Varicella-zoster virus (VZV) is a significant pathogen of viral central nervous system (CNS) infections. There are many studies on VZV-associated CNS infections, but there is currently a lack of large-sample comparative studies on VZV-associated CNS infections in immunocompetent and immunocompromised herpes zoster (HZ) patients. In this study, we compared the clinical characteristics and prognosis of VZV-associated CNS infections in immunocompetent and immunocompromised HZ patients. Methods This retrospective study, conducted at a tertiary hospital specializing in dermatology in East China, compares clinical characteristics, treatment, and prognosis at discharge in 117 immunocompetent and 49 immunocompromised HZ patients with VZV-associated CNS infection. Results Compared with the immunocompetent group, the incidence of encephalitis in immunocompromised HZ patients with VZV-associated CNS infections was significantly higher (P<0.05), and the prognosis at discharge was worse (P<0.01). Blood white blood cell (WBC), red blood cell (RBC), blood platelet counts (BPC), hemoglobin (Hb), total protein, prealbumin, and albumin contents decreased (all P<0.05), while adenosine deaminase (ADA) levels in cerebrospinal fluid (CSF) and blood C-reactive protein-to-albumin ratio (CAR), systemic immune-inflammation index (SII), C-reactive protein (CRP), and β2 microglobulin levels were higher (all P<0.05). Further analysis revealed that the time between neurological symptoms and antiviral therapy and the occurrence of encephalitis were independent risk factors for poor prognosis at discharge in immunocompetent HZ patients with CNS infections, while the independent risk factors for poor prognosis in the immunocompromised group were age and the time between neurological symptoms and antiviral therapy. Conclusions Immunocompromised HZ patients have a higher incidence of encephalitis and worse prognosis. Regardless of immunocompetent or immunocompromised HZ patients with concurrent CNS infections, the time between neurological symptoms and antiviral therapy is an independent risk factor for prognosis at discharge, highlighting the importance of early intervention and treatment.