Varicella zoster virus infections in immunocompromised hosts. A review of the natural history and management.
Varicella zoster virus infections in immunocompromised hosts. A review of the natural history and management.
复制标题
DOI：
--
复制
发表时间：
1988
期刊：
影响因子：
--
通讯作者：
H. Balfour
中科院分区：
文献类型：
--
作者：
H. Balfour
在其他方面正常的儿童中，水痘相对较轻，他们在发病后平均四天内形成新的皮损，并在八天内治愈50%的皮损。大多数免疫功能低下的儿童会在超过五天的时间内形成新的病变，那些没有接受抗病毒药物治疗的儿童肺炎的发病率为28%，死亡率为7%。未经治疗的带状疱疹脱皮病毒成人免疫功能受损时间(7.0天)长于正常成人(5.3天)。带状疱疹在免疫功能低下的宿主中比在免疫能力强的宿主中更有可能经皮肤传播。内脏播散在免疫功能正常的患者中是一种罕见的事件，在免疫功能正常的带状疱疹患者中，8%的预期免疫受损宿主会发生内脏播散。阿昔洛韦已被发现在治疗水痘和带状疱疹方面优于阿达拉滨。是否应该使用类固醇治疗带状疱疹仍然存在争议。对静脉注射阿昔洛韦的担忧包括肾脏和中枢神经系统功能障碍的副作用以及出现耐药病毒株的可能性。事实证明，这些担忧都不会阻碍免疫功能低下患者的成功治疗。未来的主要挑战是找到一种治疗水痘带状疱疹病毒感染的最佳方法，口服阿昔洛韦或其同系物。
Varicella is relatively mild in otherwise normal children, in whom new lesions form for a mean of four days after onset and heal 50 percent of their lesions in eight days. New lesions form in most immunocompromised children for longer than five days and those not treated with antiviral drugs have a 28 percent incidence of pneumonitis and a 7 percent mortality rate. Untreated immunocompromised adults with herpes zoster shed virus for longer (7.0 days) than otherwise normal adults (5.3 days). Herpes zoster is much more likely to disseminate cutaneously in immunocompromised than in immunocompetent hosts. Visceral dissemination, which is a rare event in immunocompetent patients, occurred in 8 percent of prospectively followed untreated immunocompromised hosts with herpes zoster. Acyclovir has been found to be superior to vidarabine for treatment of both chickenpox and herpes zoster. Whether or not steroids should be used to treat herpes zoster remains controversial. Concerns about the use of intravenous acyclovir include the side effects of renal and central nervous system dysfunction and the possibility of emergence of resistant viral strains. None of these concerns has proved to be an impediment to successful treatment of immunocompromised patients. The major future challenge is to find an optimal way to treat varicella zoster virus infections with oral formulations of acyclovir or its congeners.