Levy M, Hentgen V, Marque-Juillet S, Fiot E, Fagherazzi G, Nathanson S, Foucaud P
Service de pédiatrie néonatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 le Chesnay, France.
Service de pédiatrie néonatologie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 le Chesnay, France.
Arch Pediatr. 2015 May;22(5):491-7. doi: 10.1016/j.arcped.2015.02.001. Epub 2015 Mar 24.
Varicella-zoster virus (VZV) is, like other alphaherpes viruses, neurotropic. Of the admissions to hospital for varicella, 7.6-25% are due to neurologic manifestations. Most of the time, the concomitant skin lesions facilitate the diagnosis. The justification of qualitative PCR (polymerase chain reaction) for VZV DNA in cerebrospinal fluid in the management of these patients is not clear. The aim of this study was to evaluate the prognostic value of qualitative PCR for VZV DNA in cerebrospinal fluid and to assess its impact on patient management. We conducted a retrospective monocentric study in Versailles Hospital (France). It included every child admitted for neurologic manifestations associated with varicella and compared the patients with positive PCR for VZV DNA to those with a negative PCR in the cerebrospinal fluid. Seven patients with positive PCR and 16 patients with negative PCR were included. The median age of the children included was 3 years (range, 1.6-12 years) and 2 years (range, 0.6-5 years), respectively. In the positive PCR group, 86% of the children had fever on first examination and the average time between the onset of skin lesions and neurological signs was +1.28 days (range, -2 to +5 days). In comparison, in the negative PCR group, 81% of the children had fever and the average time delay was +1.75 days (-2 to +7 days). There was no significant difference in terms of length of hospitalization; 3 days (range, 0-6 days) and 3 days (range, 2-7 days), respectively. All patients discharged from our department went home. In addition, there was no significant difference between the two groups in terms of treatment with acyclovir; two children (28.5%) were treated in the positive PCR group versus four (25%) in the negative PCR group. Our study showed no prognostic value for qualitative PCR for VZV DNA in the cerebrospinal fluid of patients with neurologic manifestations of varicella. Therefore, its relevance can be questioned in clinical practice. However, in case of encephalitis and meningitis during primary infection with VZV, quantitative PCR for VZV DNA might have a prognostic value and therefore requires further study.
水痘带状疱疹病毒（VZV）与其他α疱疹病毒一样，具有嗜神经性。因水痘住院的患者中，7.6% - 25%是由神经系统表现所致。大多数情况下，伴随的皮肤损害有助于诊断。对于这些患者，脑脊液中VZV DNA定性聚合酶链反应（PCR）的合理性尚不清楚。本研究的目的是评估脑脊液中VZV DNA定性PCR的预后价值，并评估其对患者管理的影响。我们在法国凡尔赛医院进行了一项回顾性单中心研究。研究纳入了每一位因与水痘相关的神经系统表现而入院的儿童，并将脑脊液VZV DNA PCR检测呈阳性的患者与呈阴性的患者进行比较。纳入了7例PCR检测呈阳性的患者和16例PCR检测呈阴性的患者。纳入儿童的中位年龄分别为3岁（范围1.6 - 12岁）和2岁（范围0.6 - 5岁）。在PCR检测呈阳性的组中，86%的儿童首次检查时有发热，皮肤损害出现至神经症状出现的平均时间为 +1.28天（范围 -2至 +5天）。相比之下，在PCR检测呈阴性的组中，81%的儿童有发热，平均时间延迟为 +1.75天（ -2至 +7天）。住院时间方面无显著差异；分别为3天（范围0 - 6天）和3天（范围2 - 7天）。所有从我们科室出院的患者均回家。此外，两组在使用阿昔洛韦治疗方面无显著差异；PCR检测呈阳性的组中有2名儿童（28.5%）接受了治疗，而PCR检测呈阴性的组中有4名（25%）。我们的研究表明，对于有水痘神经系统表现的患者，脑脊液中VZV DNA定性PCR无预后价值。因此，其在临床实践中的相关性值得质疑。然而，在VZV初次感染期间发生脑炎和脑膜炎的情况下，VZV DNA定量PCR可能具有预后价值，因此需要进一步研究。
