Balfour H H
Department of Laboratory Medicine and Pathology, University of Minnesota Health Sciences Center, Minneapolis 55455.
Am J Med. 1988 Aug 29;85(2A):68-73.
Varicella is relatively mild in otherwise normal children, in whom new lesions form for a mean of four days after onset and heal 50 percent of their lesions in eight days. New lesions form in most immunocompromised children for longer than five days and those not treated with antiviral drugs have a 28 percent incidence of pneumonitis and a 7 percent mortality rate. Untreated immunocompromised adults with herpes zoster shed virus for longer (7.0 days) than otherwise normal adults (5.3 days). Herpes zoster is much more likely to disseminate cutaneously in immunocompromised than in immunocompetent hosts. Visceral dissemination, which is a rare event in immunocompetent patients, occurred in 8 percent of prospectively followed untreated immunocompromised hosts with herpes zoster. Acyclovir has been found to be superior to vidarabine for treatment of both chickenpox and herpes zoster. Whether or not steroids should be used to treat herpes zoster remains controversial. Concerns about the use of intravenous acyclovir include the side effects of renal and central nervous system dysfunction and the possibility of emergence of resistant viral strains. None of these concerns has proved to be an impediment to successful treatment of immunocompromised patients. The major future challenge is to find an optimal way to treat varicella zoster virus infections with oral formulations of acyclovir or its congeners.
水痘在其他方面正常的儿童中病情相对较轻，这些儿童在发病后平均四天会出现新的皮疹，并在八天内50%的皮疹愈合。大多数免疫功能低下的儿童会在五天以上出现新的皮疹，未经抗病毒药物治疗的儿童肺炎发病率为28%，死亡率为7%。未经治疗的免疫功能低下的成人带状疱疹病毒脱落时间（7.0天）比其他方面正常的成人（5.3天）更长。与免疫功能正常的宿主相比，免疫功能低下的宿主中带状疱疹更易发生皮肤播散。内脏播散在免疫功能正常的患者中是罕见事件，在接受前瞻性随访的未经治疗的免疫功能低下的带状疱疹宿主中有8%发生。已发现阿昔洛韦在治疗水痘和带状疱疹方面优于阿糖腺苷。是否应使用类固醇治疗带状疱疹仍存在争议。对静脉注射阿昔洛韦的担忧包括肾脏和中枢神经系统功能障碍的副作用以及出现耐药病毒株的可能性。但这些担忧均未被证明是成功治疗免疫功能低下患者的障碍。未来的主要挑战是找到用阿昔洛韦口服制剂或其同类物治疗水痘带状疱疹病毒感染的最佳方法。
