Echevarría J M, Casas I, Tenorio A, de Ory F, Martínez-Martín P
Servicio de Microbiología Diagnóstica, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
J Med Virol. 1994 Aug;43(4):331-5. doi: 10.1002/jmv.1890430403.
Acute aseptic meningitis (AAM) is considered as an uncommon manifestation of varicella-zoster virus (VZV) recrudescence and is usually regarded as a complication of the cutaneous infection in patients with impaired cellular immunity. Indirect evidence suggests, however, that VZV-associated AAM may also respond to direct spread of the virus to the leptomeninges from the cells supporting the latency. The polymerase chain reaction (PCR) was used to amplify VZV-specific DNA sequences in serial cerebrospinal fluid (CSF) samples from 21 patients with AAM, who presented laboratory evidence of intrathecal production of VZV-specific antibody on follow-up. Eleven of these patients never showed cutaneous zosteriform lesions. VZV-DNA sequences were detected in the CSF from all patients with cutaneous zoster, as well as from six patients (55%) lacking skin lesions. Viral DNA sequences were present in six cases before the rise in specific antibody was seen in CSF, disappearing during follow-up in the seven positive cases. These results support the proposed involvement of VZV in the etiology of AAM seen among normal young adults and strongly suggest that the virus can reach directly and infect the CNS from the latently infected spinal ganglia.
急性无菌性脑膜炎（AAM）被认为是水痘-带状疱疹病毒（VZV）复发的一种罕见表现，通常被视为细胞免疫受损患者皮肤感染的并发症。然而，间接证据表明，VZV相关的AAM也可能是由于病毒从支持潜伏状态的细胞直接传播至软脑膜所致。采用聚合酶链反应（PCR）对21例AAM患者的系列脑脊液（CSF）样本中的VZV特异性DNA序列进行扩增，这些患者在随访中均有鞘内产生VZV特异性抗体的实验室证据。其中11例患者从未出现皮肤带状疱疹样病变。所有有皮肤带状疱疹的患者以及6例（55%）无皮肤病变的患者的脑脊液中均检测到VZV-DNA序列。在6例患者的脑脊液中，在特异性抗体升高之前就已检测到病毒DNA序列，7例阳性病例在随访期间病毒DNA序列消失。这些结果支持VZV参与正常年轻成年人中AAM病因的观点，并强烈表明该病毒可从潜伏感染的脊神经节直接到达并感染中枢神经系统。
