臨床神経学

<シンポジウム20―1>難治性神経感染症update

単純ヘルペスウイルス感染症―単純ヘルペス脳炎の診断と治療―

亀井 聡

日本大学医学部内科学系神経内科学分野〔〒173―8610 東京都板橋区大谷口上町30―1〕

Recent clinical management of herpes simplex virus encephalitis (HSVE) is reviewed. The polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) has been established as a gold standard method. However, several problems for the PCR remain, as follows: the difference of minimum detection sensitivities in PCR, and pseudo-negative result which depend on the day of CSF sample collection after onset. Based on these problems, the diagnostic management of the recent guideline in USA (2008) was revised. Antiviral therapy is highly effective in reducing the mortality rate. However, only less than one-half of patients are able to return to normal. Recent therapeutic managements in EU (2007) and USA recommended acyclovir treatment for 2-3 weeks. However, according to the analysis of prolonged clinical course of HSVE (Taira N et al. 2009), such prolonged acyclovir treatment had a limited potential in their outcome. We recently reported that one pharmacological mechanism related to corticosteroid in HSVE was apparently inhibition of pro-inflammatory cytokines such as IL-6 (Kamei S et al. 2009).
Full Text of this Article in Japanese PDF (247K)

(臨床神経, 51:1040−1043, 2011)
key words:単純ヘルペス脳炎,PCR,ウイルス量,アシクロビル,サイトカイン

(受付日:2011年5月20日)