{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T17:42:47Z","timestamp":1793814167324,"version":"4.6.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with the immunocompetent group, the incidence of encephalitis in immunocompromised HZ patients with VZV-associated CNS infections was significantly higher (P&amp;lt;0.05), and the prognosis at discharge was worse (P&amp;lt;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&amp;lt;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 \u03b22 microglobulin levels were higher (all P&amp;lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1795710","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:24:23Z","timestamp":1775107463000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Varicella-zoster virus-associated central nervous system infection in immunocompromised vs. immunocompetent herpes zoster patients: a comparative study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jun","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology, Hangzhou Third People\u2019s Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanrong","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou Third People\u2019s Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou Third People\u2019s Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huili","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou Third People\u2019s Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou Third People\u2019s Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongxing","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hangzhou Third People\u2019s Hospital","place":["Zhejiang, Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/v14020192","article-title":"Herpes zoster: a review of clinical manifestations and management","volume":"14","author":"Patil","year":"2022","journal-title":"Viruses"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70267-3","article-title":"The neurotropic herpes viruses: herpes simplex and varicella-zoster","volume":"6","author":"Steiner","year":"2007","journal-title":"Lancet Neurol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30399-8","article-title":"Herpes zoster in people who are immunocompromised: what are the options for prevention","volume":"19","author":"Warren-Gash","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz1090","article-title":"Herpes zoster risk in immunocompromised adults in the United States: a systematic review","volume":"71","author":"McKay","year":"2020","journal-title":"Clin Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246086","article-title":"Herpes zoster in older adults in Ontario, 2002-2016: investigating incidence and exploring equity","volume":"16","author":"Buchan","year":"2021","journal-title":"PloS One"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2022.01.003","article-title":"Incidence of complications of herpes zoster in individuals on immunosuppressive therapy: a register-based population study","volume":"84","author":"Chawki","year":"2022","journal-title":"J Infect"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2018.06.005","article-title":"Manifestations of herpes virus infections in the nervous system","volume":"36","author":"Steiner","year":"2018","journal-title":"Neurol Clin"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s40121-024-01002-4","article-title":"The incidence of herpes zoster complications: a systematic literature review","volume":"13","author":"Giannelos","year":"2024","journal-title":"Infect Dis Ther"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000647","article-title":"Central nervous system infections produced by varicella zoster virus","volume":"33","author":"Nagel","year":"2020","journal-title":"Curr Opin Infect Dis"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.70166","article-title":"Incidence and risk factors for varicella-zoster virus-associated central nervous system infections: a nationwide Swedish retrospective case-control study","volume":"97","author":"Tyrberg","year":"2025","journal-title":"J Med Virol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/imj.70076","article-title":"Clinical characteristics and treatment of varicella zoster virus central nervous system infection in an Australian tertiary hospital","volume":"55","author":"Lam","year":"2025","journal-title":"Intern Med J"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa185","article-title":"Varicella zoster virus encephalitis in Denmark from 2015 to 2019-a nationwide prospective cohort study","volume":"72","author":"Herlin","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1554954","article-title":"Clinical characteristics of varicella-zoster virus central nervous system infection in 108 unimmunocompromised patients","volume":"16","author":"Ci","year":"2025","journal-title":"Front Neurol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.idcr.2018.e00483","article-title":"Central nervous system varicella zoster vasculopathy in an immunocompromised patient","volume":"15","author":"Guedes","year":"2018","journal-title":"IDCases"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000175","article-title":"Acute encephalitis in the immunocompromised individual","volume":"28","author":"Saylor","year":"2015","journal-title":"Curr Opin Infect Dis"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2018.08.080","article-title":"Cost of herpes zoster and herpes zoster-related complications among immunocompromised individuals","volume":"36","author":"Meyers","year":"2018","journal-title":"Vaccine"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/iid3.1038","article-title":"Cerebrospinal fluid proteomics in meningitis patients with reactivated varicella zoster virus","volume":"11","author":"Liu","year":"2023","journal-title":"Immun Inflammation Dis"},{"key":"B18","first-page":"491","article-title":"Meningitis\/meningoencephalitis caused by varicella zoster virus reactivation: a retrospective single-center case series study","volume":"14","author":"Yan","year":"2022","journal-title":"Am J Transl Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/jdv.13995","article-title":"European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV) Part 1: diagnosis","volume":"31","author":"Werner","year":"2017","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit458","article-title":"Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium","volume":"57","author":"Venkatesan","year":"2013","journal-title":"Clin Infect Dis"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s13555-018-0268-8","article-title":"Burden of herpes zoster in the Japanese population with immunocompromised\/chronic disease conditions: results from a cohort study claims database from 2005-2014","volume":"9","author":"Imafuku","year":"2019","journal-title":"Dermatol Ther (Heidelb)"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1185","article-title":"Herpes zoster and postherpetic neuralgia: changing incidence rates from 1994 to 2018 in the United States","volume":"73","author":"Thompson","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2018.10.015","article-title":"Systematic review of the evidence on the epidemiology of herpes zoster: incidence in the general population and specific subpopulations in Spain","volume":"167","author":"Mareque","year":"2019","journal-title":"Public Health"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2025.108005","article-title":"Epidemiology of herpes zoster and post-herpetic neuralgia in China: a nationwide population-based survey","volume":"159","author":"Xia","year":"2025","journal-title":"Int J Infect Dis"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2023.2228169","article-title":"The incidence of herpes zoster in China: a meta-analysis and evidence quality assessment","volume":"19","author":"Zhang","year":"2023","journal-title":"Hum Vaccin Immunother"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1186\/s12889-025-22703-6","article-title":"Herpes zoster incidence and burden in older Chinese: a systematic review and meta-analysis","volume":"25","author":"Zheng","year":"2025","journal-title":"BMC Public Health"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2025.09.018","article-title":"Varicella-zoster meningitis in immunocompetent adults: a case series and literature review","volume":"99","author":"Netterwala","year":"2026","journal-title":"Am J Emerg Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.945835","article-title":"Prospective analysis of central nervous system infection risks in varicella-zoster virus reactivation cases: a single-center prospective study of 1030 cases","volume":"30","author":"Wang","year":"2024","journal-title":"Med Sci Monit"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3201\/eid3012.240538","article-title":"Increase in adult patients with varicella zoster virus-related central nervous system infections, Japan","volume":"30","author":"Yoshikane","year":"2024","journal-title":"Emerg Infect Dis"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2022.120262","article-title":"Clinical and neuroradiologic characteristics in varicella zoster virus reactivation with central nervous system involvement","volume":"437","author":"Maher","year":"2022","journal-title":"J Neurol Sci"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1155\/cjid\/6664417","article-title":"The role of varicella zoster virus (VZV) in central nervous system infectious syndromes","volume":"2024","author":"Yakovenko","year":"2024","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s13365-016-0422-y","article-title":"Central nervous system infections caused by varicella-zoster virus","volume":"22","author":"Chamizo","year":"2016","journal-title":"J Neurovirol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.23470","article-title":"Viral infections of the central nervous system in Spain: a prospective study","volume":"85","author":"de Ory","year":"2013","journal-title":"J Med Virol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2017.07.016","article-title":"Aseptic meningitis in adults and children: diagnostic and management challenges","volume":"94","author":"Shukla","year":"2017","journal-title":"J Clin Virol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.2217\/fmb-2023-0107","article-title":"Varicella zoster viral encephalitis without herpes: diagnosis by metagenomic next-generation sequencing of cerebrospinal fluid","volume":"18","author":"Hong","year":"2023","journal-title":"Future Microbiol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.3344\/kjp.2020.33.3.208","article-title":"Zoster sine herpete: a review","volume":"33","author":"Zhou","year":"2020","journal-title":"Korean J Pain"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-021-04245-y","article-title":"Characteristics and outcome of varicella-zoster virus central nervous system infections in adults","volume":"40","author":"Le Bot","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1007\/s13365-017-0519-y","article-title":"Incidence of varicella zoster virus infections of the central nervous system in the elderly: a large tertiary hospital-based series (2007-2014)","volume":"23","author":"Arruti","year":"2017","journal-title":"J Neurovirol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000922","article-title":"Viral meningitis and encephalitis: an update","volume":"36","author":"Gundamraj","year":"2023","journal-title":"Curr Opin Infect Dis"},{"key":"B40","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1007\/s13365-020-00872-x","article-title":"Clinical spectrum and prognosis of neurological complications of reactivated varicella-zoster infection: the role of immunosuppression","volume":"26","author":"Corral","year":"2020","journal-title":"J Neurovirol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.938057","article-title":"Factors predictive of varicella zoster virus encephalitis\/meningitis: a single-center, retrospective study","volume":"28","author":"Yuan","year":"2022","journal-title":"Med Sci Monit"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2013.01.031","article-title":"Infection of the central nervous system caused by varicella zoster virus reactivation: a retrospective case series study","volume":"17","author":"Lozano Becerra","year":"2013","journal-title":"Int J Infect Dis"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1795710\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:24:24Z","timestamp":1775107464000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1795710\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":42,"alternative-id":["10.3389\/fimmu.2026.1795710"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1795710","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]},"article-number":"1795710"}}