Abstract：
UNASSIGNED: Systematic treatment with intravenous acyclovir is usually given when varicella zoster virus (VZV) DNA is isolated in cerebrospinal fluid (CSF), indicating central nervous system (CNS) involvement. Our study aimed to describe therapeutic management and acute kidney injury (AKI) occurrence during acyclovir treatment of VZV infection with CNS involvement.
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.
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.
摘要：
■当在脑脊液（CSF）中分离水痘带状疱疹病毒（VZV）DNA时，通常给予静脉注射阿昔洛韦的系统治疗，提示中枢神经系统（CNS）受累。我们的研究旨在描述阿昔洛韦治疗中枢神经系统受累的VZV感染的治疗管理和急性肾损伤（AKI）的发生。
■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。
■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。
