Gray F, Bélec L, Lescs M C, Chrétien F, Ciardi A, Hassine D, Flament-Saillour M, de Truchis P, Clair B, Scaravilli F
Département de Pathologie (Neuropathologie), Hôpital Henri Mondor, Faculté de Médecine de Créteil, Université Paris-Val de Marne, France.
Brain. 1994 Oct;117 ( Pt 5):987-99. doi: 10.1093/brain/117.5.987.
Productive varicella-zoster virus (VZV) infection of the central nervous system (CNS) was demonstrated in 11 acquired immune deficiency syndrome (AIDS) patients using immunocytochemistry and in situ hybridization. A characteristic zoster skin eruption was seen in only four cases. From our own series and 11 other cases in the literature, we identified five clinico-pathological patterns of VZV infection of the CNS in AIDS patients which could occur simultaneously. (i) Multifocal encephalitis predominantly involving the white matter, likely to be due to haematogenous spread of the infection was found in four cases. (ii) Ventriculitis was found in three cases. In two cases there was complete acute or chronic necrosis of the ventricular wall with marked vasculitis; in the third, the ependymal lining appeared irregular with foci of VZV-infected ependymal cells, some of which protruded into the ventricular lumen. (iii) Acute haemorrhagic meningo-myeloradiculitis with necrotizing vasculitis was observed in two cases. In one, this was associated with ventriculitis and was possibly due to shedding of infected ependymal cells into the ventricular lumen and secondary seeding of the CSF. (iv) Focal necrotizing myelitis was seen in one case. It followed cutaneous herpes zoster and was considered to result from neural spread from the diseased dorsal root ganglion similar to cases previously described of encephalitis limited to the visual system following VZV ophthalmicus, or bulbar encephalitis following a trigeminal zoster. (v) Vasculopathy involving leptomeningeal arteries and causing cerebral infarcts was seen in four cases, it was associated with meningitis in most cases. These findings are in keeping with the observation in non-AIDS patients that VZV spread to the CNS may follow different routes. Our study tends to show that VZV infection of the CNS occurs more frequently in AIDS than previously suspected and suggests that it must be considered as a diagnosis in cases of encephalitis, ventriculitis, focal myelitis, acute myeloradiculitis and cerebral infarcts in these patients.
通过免疫细胞化学和原位杂交技术，在11例获得性免疫缺陷综合征（AIDS）患者中证实了中枢神经系统（CNS）发生了水痘-带状疱疹病毒（VZV）的有效感染。仅4例患者出现了典型的带状疱疹皮肤疹。根据我们自己的病例系列以及文献中的其他11个病例，我们确定了AIDS患者中VZV感染CNS的五种临床病理模式，这些模式可能同时出现。（i）4例患者出现多灶性脑炎，主要累及白质，可能是由于感染经血行播散所致。（ii）3例患者出现脑室炎。2例患者的脑室壁出现完全性急性或慢性坏死，并伴有明显的血管炎；第3例患者的室管膜内衬不规则，有VZV感染的室管膜细胞灶，其中一些突入室腔。（iii）2例患者出现急性出血性脑膜脊髓神经根炎伴坏死性血管炎。其中1例与脑室炎有关，可能是由于感染的室管膜细胞脱落在脑室腔，继而脑脊液播散所致。（iv）1例患者出现局灶性坏死性脊髓炎。该病例继发于皮肤带状疱疹，被认为是由患病的背根神经节神经播散引起的，类似于先前描述的VZV眼炎后局限于视觉系统的脑炎，或三叉神经带状疱疹后的延髓脑炎。（v）4例患者出现累及软脑膜动脉并导致脑梗死的血管病变，大多数病例伴有脑膜炎。这些发现与非AIDS患者中观察到的VZV传播至CNS可能遵循不同途径的情况一致。我们的研究倾向于表明，AIDS患者中CNS的VZV感染比以前怀疑的更为常见，并提示在这些患者出现脑炎、脑室炎、局灶性脊髓炎、急性脊髓神经根炎和脑梗死时，必须考虑将其作为一种诊断。
