PDF(Pubmed)
Abstract：
Varicella-zoster virus (VZV), known for causing chickenpox, establishes latent infections in neural tissues. Reactivation of VZV can lead to herpes zoster (HZ) and various neurological complications. In this report, we present four cases of VZV meningitis and myelitis following amenamevir treatment for HZ dermatitis with positive VZV DNA in cerebrospinal fluid (CSF) revealed by polymerase chain reaction (PCR). Three of them were considered immunocompromised hosts given the fact that two of these patients were taking immunosuppressive drugs for rheumatoid arthritis, and one patient had a history of sigmoid colon cancer (four months after resection). After HZ onset, amenamevir, which has poor CSF transfer, was prescribed for all the patients, and all of them developed central nervous complications by VZV (meningitis in three cases and myelitis in one case) confirmed by PCR. All the patients were treated with acyclovir, which has a higher CSF transfer, and fully recovered. We speculate that amenamevir might have failed to prevent VZV infection in the central nervous system (CNS) and think that consideration should be given to administering acyclovir in preference to amenamevir for ΗΖ patients at high risk of CNS VZV infection, such as immunocompromised hosts.
摘要：
水痘-带状疱疹病毒(VZV),以引起水痘而闻名,在神经组织中建立潜伏感染。VZV的再激活可导致带状疱疹（HZ）和各种神经系统并发症。在这份报告中,我们介绍了4例VZV脑膜炎和脊髓炎病例，这些病例是在amenamevir治疗HZ皮炎后，通过聚合酶链反应（PCR）发现脑脊液（CSF）中VZVDNA阳性。考虑到其中两名患者正在服用类风湿关节炎的免疫抑制药物，其中三名被认为是免疫受损的宿主，1例患者有乙状结肠癌病史（切除后4个月）。HZ发病后，amenamevir,脑脊液转移不良，是给所有病人开的，经PCR证实，VZV（3例脑膜炎和1例脊髓炎）均出现中枢神经并发症。所有患者均给予阿昔洛韦治疗,具有更高的CSF转移，并完全恢复。我们推测，amenamevir可能无法预防中枢神经系统（CNS）中的VZV感染，并认为应考虑给予阿昔洛韦优先于amenamevir治疗中枢神经系统VZV感染高危患者，如免疫受损的宿主。
