Whitley R J
Department of Pediatrics, University of Alabama, Birmingham 35294.
Am J Med. 1988 Aug 29;85(2A):61-7.
Herpes simplex virus (HSV) infections of the central nervous system are a significant cause of mortality and morbidity. The introduction of antiviral therapy has improved the outcome for patients with life-threatening disease. Neonatal HSV infection is usually acquired at the time of delivery by contact of the fetus with infected maternal genital secretions resulting in disease that can be localized to the skin, eye, and mouth, and can lead to encephalitis or become disseminated. A total of 291 babies with neonatal HSV infection have been evaluated over a period of 14 years with mortality and morbidity rates determined at one year. Vidarabine therapy decreased the incidence of mortality and improved morbidity rates; however, further improvement in mortality rates with acyclovir therapy has not been apparent. No significant clinical toxicity appeared in either treatment group. In order to improve outcome, earlier intervention and prophylactic strategies must be developed. For patients with herpes simplex encephalitis, acyclovir therapy is superior to vidarabine therapy for biopsy-proven disease. When outcome is compared for 136 vidarabine- and 46 acyclovir-treated, biopsy-proven patients, mortality rates are decreased to 20 percent with acyclovir, and approximately 40 percent of survivors are evaluated as normal at one year after therapy. Despite better outcome with antiviral therapy for the treatment of biopsy-proven herpes simplex encephalitis, further improvement is required.
单纯疱疹病毒（HSV）引起的中枢神经系统感染是导致死亡和发病的重要原因。抗病毒疗法的引入改善了患有危及生命疾病患者的预后。新生儿HSV感染通常在分娩时通过胎儿接触受感染的母体生殖器分泌物而获得，导致疾病可局限于皮肤、眼睛和口腔，并可导致脑炎或播散。在14年的时间里，共评估了291例新生儿HSV感染的婴儿，并在1岁时确定了死亡率和发病率。阿糖腺苷疗法降低了死亡率，并改善了发病率；然而，阿昔洛韦疗法在死亡率方面并未有进一步明显改善。两个治疗组均未出现明显的临床毒性。为了改善预后，必须制定早期干预和预防策略。对于单纯疱疹性脑炎患者，对于经活检证实的疾病，阿昔洛韦疗法优于阿糖腺苷疗法。当比较136例接受阿糖腺苷治疗和46例接受阿昔洛韦治疗且经活检证实的患者的预后时，阿昔洛韦治疗组的死亡率降至20%，约40%的幸存者在治疗后1年被评估为正常。尽管抗病毒疗法治疗经活检证实的单纯疱疹性脑炎的预后较好，但仍需要进一步改善。
