Pollak L, Mehta S K, Pierson D L, Sacagiu T, Avneri Kalmanovich S, Cohrs R J
Department of Neurology, The Assaf Harofeh Medical Center, affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
Acta Neurol Scand. 2015 Jun;131(6):417-21. doi: 10.1111/ane.12335. Epub 2014 Oct 14.
Since the routine use of polymerase chain reaction testing (PCR) in diagnosing herpes infections, varicella-zoster virus is increasingly recognized as a cause of varicella-zoster meningoencephalitis (VZV ME) among immunocompetent patients. We were interested to determine whether patients with VZV ME had VZV DNA in their saliva during the acute phase of the illness.
Forty-five consecutive patients who underwent a lumbar puncture for diagnostic purposes were included in the study. The cerebrospinal fluid was examined for the presence of VZV DNA by PCR, and patients with positive findings were treated with acyclovir. The saliva was later analyzed in a blinded fashion for the presence of VZV DNA.
VZV DNA was found in saliva in four of five (80%) patients with PCR confirmed VZV ME (sensitivity 0.8, specificity 0.84, and likelihood ratio 5). This was significantly more than in patients with non-zoster viral ME (0%, P = 0.009), parainfectious headache (12%, P = 0.03) and controls (9.5%, P = 0.007). In immunocompromised patients with systemic lymphoma and AIDS, VZV DNA was present at a similar rate (67%, P = 0.6).
We have found VZV DNA in saliva of patients with PCR confirmed VZV ME at a higher proportion than in controls and patients with non-VZV viral ME. This finding might be of clinical importance, especially in immunocompetent individuals with suspected VZV ME where the results of genetic and immunological testing are not conclusive.
自从聚合酶链反应检测（PCR）常规用于诊断疱疹感染以来，水痘带状疱疹病毒越来越被认为是免疫功能正常患者发生水痘带状疱疹性脑膜脑炎（VZV ME）的病因。我们感兴趣的是确定VZV ME患者在疾病急性期的唾液中是否存在VZV DNA。
本研究纳入了连续45例因诊断目的而行腰椎穿刺的患者。通过PCR检测脑脊液中是否存在VZV DNA，对检测结果阳性的患者给予阿昔洛韦治疗。随后以盲法分析唾液中是否存在VZV DNA。
在5例经PCR确诊为VZV ME的患者中，有4例（80%）唾液中检测到VZV DNA（敏感性0.8，特异性0.84，似然比5）。这一比例显著高于非带状疱疹病毒性脑膜脑炎患者（0%，P = 0.009）、感染后头痛患者（12%，P = 0.03）和对照组（9.5%，P = 0.007）。在患有系统性淋巴瘤和艾滋病的免疫功能低下患者中，VZV DNA的存在率相似（67%，P = 0.6）。
我们发现经PCR确诊为VZV ME的患者唾液中VZV DNA的比例高于对照组和非VZV病毒性脑膜脑炎患者。这一发现可能具有临床意义，尤其是在疑似VZV ME的免疫功能正常个体中，此时基因和免疫检测结果尚无定论。
