単純ヘルペス脳炎の早期arabinoside剤治療

EARLY ADENINE ARABINOSIDE THERAPY IN HERPES SIMPLEX ENCEPHALITIS (HSE)

　抄録　単純ヘルペス脳炎（HSE）の1例でcytosine arabinoside （Ara-C）治療，5例でadenine arabi—noside （Ara-A）治療を行つた。全例とも発病様式，臨床症状，脳脊髄液所見より，初期からHSEを疑い，virus学的検査結果を待たずに，第2〜9病日に早期治療を開始した。　Ara-C治療の1例は極期における生命の危険を脱したが，失外套症候群を残し，発病1年8か月後肺炎と褥瘡により死亡した。　Ara-A治療の5例は，神経学的異常を残さなかつた1例を含む3例で社会復帰し，2例で軽度〜中等度の記銘力障害を残すが，全例生存している。年齢，性差，第2〜9病日の範囲における治療開始日の相違による治療結果への影響は明らかでなかつたが，治療開始時の意識状態が治療後の神経症状を左右したことから治療早期開始の重要性が示された。なお，極期における生命の危機に対し脳浮腫治療や抗痙攣剤治療の有用性も示唆された。

Five patients with HSE were treated with adenine arabinoside and one additional patient with cytosine arabinoside. The diagnosis of HSEwas confirmed in retrospect by the rising CF titers and the Enzyme-Linked Immunosorbent Assay (ELISA) levels in CSF (Table 2). Brain biopsy was not performed.

The treatment was started promptly when HSE was strongly suspected by symptoms and signs, EEG, CT and CSF findings before the specific laboratory data were available. The clinical and laboratory data on the 6 patients were shown in Table 1.

All the 5 patients of HSE treated with adenine arabinoside survived: 3 returned to normal daily life, including one having no neurological deficits, and the other 2 had mild to moderate memory disturbances. Improvement of CT abnormalities indicated a good prognosis. Age or sex did not have influence on the prognosis. The patient treated with cytosine arabinoside died of compli-cations after being in a state of apallic syndromefor 1 year and 8 months.

On the basis of the analysis of our patients, one of the crucial factors in the treatment of HSE seems to be the earliest possible use of adenine arabinoside : in our patients on the 2nd up to 9th day of onset, although there was no correlation between the day the medication was started and the morbidity.

The other important factor includes the manage-ment of acute stage of HSE: the treatment of cerebral edema and generalized convulsions. The major side effects of adenine arabinoside included diarrhea (one case), elevation of GOT, GPT or LDH (one case) which all improved after the treatment.

Adenine arabinoside could be an effective drug for HSE reducing the mortality and morbidity with few side effects.