Iten A, Chatelard P, Vuadens P, Miklossy J, Meuli R, Sahli R, Meylan P R
Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Neurovirol. 1999 Apr;5(2):172-80. doi: 10.3109/13550289909021999.
Over a 2 year period, we identified five HIV-infected patients who presented with central nervous system infection caused by varicella-zoster virus, three with myelitits, and two with meningoencephalitis. All five patients were profoundly immunocompromised. Clinical presentation of these patients overlapped to a significant extent with diseases caused by other viruses, e.g. CMV. Indeed, in one case, a dual infection with CMV was diagnosed, but the respective role of each virus was ascertained by in situ hybridisation. At the time of CNS involvement, only one patient had active VZV cutaneous lesions, which were instrumental in diagnosing her condition. In contrast, PCR for VZV DNA in the CSF was helpful in making a diagnosis in the four other cases, one of which was confirmed by a post mortem. Of these five patients, two patients developed VZV disease while receiving oral acyclovir and had foscarnet treatment initiated when MRI demonstrated widespread lesions. They did not respond to antiviral therapy. The three other patients had intravenous acyclovir initiated at a time when no or limited parenchymal lesions were observed by MRI. Two of these three patients had VZV infection diagnosed solely on the basis of PCR: all three responded to treatment. Our data show that reactivation of VZV involving the central nervous system occurs frequently in the absence of cutaneous lesions. PCR of cerebrospinal fluid may help in making an early diagnosis which is probably a prerequisite for successful treatment of VZV infection of the CNS.
在两年时间里，我们确定了5例感染人类免疫缺陷病毒（HIV）且出现由水痘-带状疱疹病毒引起的中枢神经系统感染的患者，其中3例患脊髓炎，2例患脑膜脑炎。所有5例患者均存在严重免疫功能低下。这些患者的临床表现与其他病毒（如巨细胞病毒）引起的疾病在很大程度上重叠。事实上，在1例患者中诊断出合并巨细胞病毒双重感染，但通过原位杂交确定了每种病毒各自的作用。在中枢神经系统受累时，只有1例患者有活动性水痘-带状疱疹病毒皮肤损害，这对诊断其病情有帮助。相比之下，脑脊液中水痘-带状疱疹病毒DNA的聚合酶链反应（PCR）有助于对其他4例患者做出诊断，其中1例经尸检证实。在这5例患者中，2例在接受口服阿昔洛韦治疗时发生了水痘-带状疱疹病毒疾病，当磁共振成像（MRI）显示广泛病变时开始使用膦甲酸钠治疗。他们对抗病毒治疗无反应。另外3例患者在MRI未观察到实质性病变或仅有局限性病变时开始静脉注射阿昔洛韦。这3例患者中有2例仅根据PCR诊断出水痘-带状疱疹病毒感染：3例患者均对治疗有反应。我们的数据表明，在无皮肤损害的情况下，累及中枢神经系统的水痘-带状疱疹病毒再激活很常见。脑脊液PCR可能有助于早期诊断，而早期诊断可能是成功治疗中枢神经系统水痘-带状疱疹病毒感染的先决条件。
