Impact of cerebrospinal fluid PCR on the management of HIV-infected patients with varicella-zoster virus infection of the central nervous system

Détails

ID Serval
serval:BIB_1879B4E682FD
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Etude de cas (case report): rapporte une observation et la commente brièvement.
Collection
Publications
Institution
Titre
Impact of cerebrospinal fluid PCR on the management of HIV-infected patients with varicella-zoster virus infection of the central nervous system
Périodique
J Neurovirol
Auteur(s)
Iten  A., Chatelard  P., Vuadens  P., Miklossy  J., Meuli  R., Sahli  R., Meylan  P. R.
ISSN
1355-0284
Statut éditorial
Publié
Date de publication
04/1999
Peer-reviewed
Oui
Volume
5
Numéro
2
Pages
172-80
Langue
anglais
Notes
Case Reports
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Apr
Résumé
Over a 2 year period, we identified five HIV-infected patients who presented with central nervous system infection caused by varicella-zoster virus, three with myelitits, and two with meningoencephalitis. All five patients were profoundly immunocompromised. Clinical presentation of these patients overlapped to a significant extent with diseases caused by other viruses, e.g. CMV. Indeed, in one case, a dual infection with CMV was diagnosed, but the respective role of each virus was ascertained by in situ hybridisation. At the time of CNS involvement, only one patient had active VZV cutaneous lesions, which were instrumental in diagnosing her condition. In contrast, PCR for VZV DNA in the CSF was helpful in making a diagnosis in the four other cases, one of which was confirmed by a post mortem. Of these five patients, two patients developed VZV disease while receiving oral acyclovir and had foscarnet treatment initiated when MRI demonstrated widespread lesions. They did not respond to antiviral therapy. The three other patients had intravenous acyclovir initiated at a time when no or limited parenchymal lesions were observed by MRI. Two of these three patients had VZV infection diagnosed solely on the basis of PCR: all three responded to treatment. Our data show that reactivation of VZV involving the central nervous system occurs frequently in the absence of cutaneous lesions. PCR of cerebrospinal fluid may help in making an early diagnosis which is probably a prerequisite for successful treatment of VZV infection of the CNS.
Mots-clé
AIDS-Related Opportunistic Infections/cerebrospinal fluid/diagnosis/drug therapy/virology Acyclovir/therapeutic use Adult Antiviral Agents/therapeutic use Central Nervous System Infections/cerebrospinal fluid/diagnosis/drug therapy/virology Cytomegalovirus/isolation & purification DNA, Viral/analysis Female Foscarnet/therapeutic use HIV Infections/*complications Herpes Zoster/*cerebrospinal fluid/diagnosis/drug therapy Herpesvirus 3, Human/genetics/*isolation & purification Humans Immunocompromised Host In Situ Hybridization Male Middle Aged *Polymerase Chain Reaction
Pubmed
Web of science
Création de la notice
08/04/2008 14:48
Dernière modification de la notice
06/09/2019 10:42
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