総説

著者

亀　　井　　　　　聡
日本大学医学部内科学講座神経内科部門

要旨

Recent aspects of diagnostic and therapeutic managements are reviewed based on our clinical analysis of adult patientswith herpes simplex virus encephalitis (HSVE). Recent Japanese and European clinical guidelines for HSVE are reviewed.Clinical diagnosis of HSVE is essentially based on the detection of HSV-DNA in cerebrospinal fluid using PCRand/or the estimation of intrathecal antibody production for HSV in both these clinical guidelines. The first therapeuticmanagement for HSVE is a treatment with aciclovir. This antiviral therapy is highly effective in reducing the rate ofmortality from HSVE. However, only less than one-half of HSVE patients are able to return to normal. This findingindicates the need to develop a further improved therapeutic regime for HSVE. An age of over 30 years, a duration of over4 days after onset at the initiation of antiviral therapy, a Glasgow Coma scale (GCS) of 6 points or less, and the detectionof focal lesions by cranial computed tomography (CT) at the initiation of therapy have been reported as predictors of apoor outcome in HSVE. These previous investigations were undertaken by single variable analysis. Our data indicatedthat the initial and maximum values of the intrathecal viral load yielded by nested PCR were not correlated with theoutcome of HSVE. Such absence of a clear correlation between viral load in the CSF and outcome therefore suggests thepossible existence of host-sided mechanisms. Moreover, we analyzed these predictors by multiple logistic analysis. Apoor outcome was evident in the case of older aged patients, lower GCS scores at initiation of aciclovir, and non-treatmentwith corticosteroid under aciclovir therapy. This result indicated that combination therapy using corticosteroidtreatment under aciclovir administration might be effective for achieving a better outcome in adult patients with HSVE.

keyword

herpes simplex virus encephalitis, epidemiology, diagnosis, treatment, prognosis
単純ヘルペスウイルス脳炎，疫学，診断，治療，予後