Breton G, Fillet A M, Katlama C, Bricaire F, Caumes E
Department of Infectious and Tropical Diseases, Hôpital Pitié Salpétrière, Paris, France.
Clin Infect Dis. 1998 Dec;27(6):1525-7. doi: 10.1086/515045.
We retrospectively studied 18 consecutive cases of acyclovir-resistant zoster. All the patients had chronic skin lesions that failed to heal despite treatment with intravenous acyclovir (30 mg/[kg.d]) in 15 cases and oral acyclovir (4 g/d) in three cases for > 10 days. The mean CD4+ cell count was 20 x 10(6)/L. The mean number of previous zoster episodes was 1.53. Fifteen of the 16 patients evaluable for previous acyclovir treatment had received the drug. Thirteen patients were treated with intravenous foscarnet (200 mg/[kg.d]) for a mean of 17.8 days. Complete healing was observed in 10 (77%) of the 13 treated patients. Zoster relapsed after cessation of foscarnet therapy in five of the 10 responding patients. The median time to relapse was 110 days. Four patients died of varicella-zoster virus-associated visceral complications. These results show that acyclovir-resistant zoster has a poor prognosis but responds well to foscarnet therapy.
我们回顾性研究了18例连续性阿昔洛韦耐药性带状疱疹病例。所有患者均有慢性皮肤损害，15例接受静脉注射阿昔洛韦（30mg/[kg·d]）治疗、3例接受口服阿昔洛韦（4g/d）治疗超过10天，皮肤损害仍未愈合。平均CD4 +细胞计数为20×10⁶/L。既往带状疱疹发作的平均次数为1.53次。16例可评估既往阿昔洛韦治疗情况的患者中，15例曾接受过该药物治疗。13例患者接受静脉注射膦甲酸钠（200mg/[kg·d]）治疗，平均治疗17.8天。13例接受治疗的患者中，10例（77%）实现完全愈合。10例有反应的患者中，5例在膦甲酸钠治疗停止后带状疱疹复发。复发的中位时间为110天。4例患者死于水痘 - 带状疱疹病毒相关的内脏并发症。这些结果表明，阿昔洛韦耐药性带状疱疹预后较差，但对膦甲酸钠治疗反应良好。
