PDF(Pubmed)
Abstract：
UNASSIGNED: Varicella zoster virus (VZV) can reactivate and cause meningitis, but few studies have distinguished it from meningoencephalitis regarding treatment recommendations.The objective of this study was to assess the outcomes of a large series of patients with VZV meningitis according to their therapeutic management.
UNASSIGNED: We conducted a bicentric retrospective cohort study, in Paris, France, including all adult patients with a cerebrospinal fluid sample positive for VZV by polymerase chain reaction between April 2014 and June 2022. We distinguished meningitis from encephalitis according to the International Encephalitis Consortium criteria. Unfavorable outcome was defined as mortality or functional sequelae defined by a loss of 2 points on the modified Rankin Scale.
UNASSIGNED: We included 123 patients with meningitis. Among them, 14% received no antivirals, while 20% were treated with oral valacyclovir alone, 41% with a short course of intravenous (IV) acyclovir before switch to valacyclovir, and 25% with a long course of IV acyclovir. Outcomes were favorable regardless of antiviral regimen. In multivariate analysis, only age, underlying immunosuppression, and cranial radiculitis appear to be predictive factors for longer IV therapy, based on the Akaike information criterion.
UNASSIGNED: In this study, patients with VZV meningitis had a good outcome, with no evidence of any impact of the treatment strategy. However, further studies are needed to support the possibility of milder treatment in immunocompetent patients, avoiding cost and side effects of IV acyclovir.
UNASSIGNED: We conducted a bicentric retrospective cohort study, in Paris, France, including all adult patients with a cerebrospinal fluid sample positive for VZV by polymerase chain reaction between April 2014 and June 2022. We distinguished meningitis from encephalitis according to the International Encephalitis Consortium criteria. Unfavorable outcome was defined as mortality or functional sequelae defined by a loss of 2 points on the modified Rankin Scale.
UNASSIGNED: We included 123 patients with meningitis. Among them, 14% received no antivirals, while 20% were treated with oral valacyclovir alone, 41% with a short course of intravenous (IV) acyclovir before switch to valacyclovir, and 25% with a long course of IV acyclovir. Outcomes were favorable regardless of antiviral regimen. In multivariate analysis, only age, underlying immunosuppression, and cranial radiculitis appear to be predictive factors for longer IV therapy, based on the Akaike information criterion.
UNASSIGNED: In this study, patients with VZV meningitis had a good outcome, with no evidence of any impact of the treatment strategy. However, further studies are needed to support the possibility of milder treatment in immunocompetent patients, avoiding cost and side effects of IV acyclovir.
摘要：
■水痘带状疱疹病毒（VZV）可以重新激活并引起脑膜炎，但在治疗建议方面，很少有研究将其与脑膜脑炎区分开来。这项研究的目的是根据治疗管理评估大量VZV脑膜炎患者的预后。
■我们进行了一项双中心回顾性队列研究，在巴黎,法国,包括2014年4月至2022年6月期间经聚合酶链反应检测VZV脑脊液样本呈阳性的所有成年患者.我们根据国际脑炎联盟的标准将脑膜炎与脑炎区分开。不良结局定义为死亡率或功能性后遗症，定义为在改良的Rankin量表上损失2分。
■我们纳入了123例脑膜炎患者。其中,14%的人没有接受抗病毒药物，而20％的人单独口服伐昔洛韦治疗，41％的人在改用伐昔洛韦之前接受短期静脉（IV）阿昔洛韦，25%的人长期静脉注射阿昔洛韦。无论抗病毒方案如何，结果都是有利的。在多变量分析中，只有年龄,潜在的免疫抑制，和颅骨根炎似乎是长期静脉治疗的预测因素，基于Akaike信息标准。
■在这项研究中，VZV脑膜炎患者预后良好，没有证据表明治疗策略有任何影响。然而,需要进一步的研究来支持对有免疫能力的患者进行温和治疗的可能性，避免IV阿昔洛韦的成本和副作用。
■我们进行了一项双中心回顾性队列研究，在巴黎,法国,包括2014年4月至2022年6月期间经聚合酶链反应检测VZV脑脊液样本呈阳性的所有成年患者.我们根据国际脑炎联盟的标准将脑膜炎与脑炎区分开。不良结局定义为死亡率或功能性后遗症，定义为在改良的Rankin量表上损失2分。
■我们纳入了123例脑膜炎患者。其中,14%的人没有接受抗病毒药物，而20％的人单独口服伐昔洛韦治疗，41％的人在改用伐昔洛韦之前接受短期静脉（IV）阿昔洛韦，25%的人长期静脉注射阿昔洛韦。无论抗病毒方案如何，结果都是有利的。在多变量分析中，只有年龄,潜在的免疫抑制，和颅骨根炎似乎是长期静脉治疗的预测因素，基于Akaike信息标准。
■在这项研究中，VZV脑膜炎患者预后良好，没有证据表明治疗策略有任何影响。然而,需要进一步的研究来支持对有免疫能力的患者进行温和治疗的可能性，避免IV阿昔洛韦的成本和副作用。
