UNASSIGNED: Multicentre, retrospective study including all patients from 2010 to 2022 with VZV DNA in CSF. Patient management and outcomes were compared according to clinical presentation and indications for intravenous acyclovir: i) definite (encephalitis, myelitis or stroke, peripheral nervous system (PNS) with ≥ 2 roots, herpes zoster ≥ 3 dermatomes, immunosuppression), ii) questionable (1 or 2 dermatomes) or iii) no indication (other situations).
UNASSIGNED: 154 patients were included (median age 66 (interquartile range 43-77), 87 (56%) males); 60 (39%) had encephalitis, myelitis or stroke, 35 (23%) had PNS involvement, 37 (24%) had isolated meningitis, 14 (9%) had isolated cutaneous presentation, and 8 (5%) had other presentations. Overall, 128 (83%) received intravenous acyclovir for more than 72 h. AKI occurred in 57 (37%) patients. Finally, 42 (27%) and 25 (16%) patients had respectively no or a questionable indication for intravenous acyclovir, while 29 (69%) and 23 (92%) of them received it for more than 72 h, with AKI in 13 (35%) and 13 (52%) patients, respectively. In-hospital mortality was 12% (n = 18), and no deaths were reported in isolated meningitis.
UNASSIGNED: Intravenous acyclovir is widely prescribed when VZV DNA is isolated in CSF, regardless of the clinical presentation, with a high rate of AKI. Further studies are needed to better define the value of intravenous acyclovir in isolated VZV meningitis.
■多中心,回顾性研究,包括2010年至2022年CSF中使用VZVDNA的所有患者。根据静脉注射阿昔洛韦的临床表现和适应症比较患者管理和结果:i)明确(脑炎,脊髓炎或中风,外周神经系统(PNS)与≥2根,带状疱疹≥3皮组,免疫抑制),ii)有问题(1或2皮组)或iii)没有适应症(其他情况)。
■纳入154例患者(中位年龄66(四分位距43-77),87(56%)男性);60(39%)患有脑炎,脊髓炎或中风,35人(23%)参与了PNS,37人(24%)患有孤立性脑膜炎,14(9%)有孤立的皮肤表现,8人(5%)有其他陈述。总的来说,128例(83%)接受静脉阿昔洛韦治疗超过72小时。57例(37%)患者发生AKI。最后,42(27%)和25(16%)患者分别没有或有可疑的静脉阿昔洛韦适应症,其中29人(69%)和23人(92%)接受超过72小时,13例(35%)和13例(52%)患者发生AKI,分别。住院死亡率为12%(n=18),在孤立性脑膜炎中没有死亡报告。
■当在CSF中分离VZVDNA时,静脉内阿昔洛韦被广泛使用,不管临床表现如何,AKI的发生率很高。需要进一步的研究来更好地确定静脉注射阿昔洛韦在孤立的VZV脑膜炎中的价值。