日本未熟児新生児学会雑誌　第20巻　第2号　103～107頁（2008年）

日本未熟児新生児学会雑誌　20(2)： 295-299；2008　

受付日：平成19．12．03

受理日：平成20．02．19

Real-time PCR法を治療効果判定に用い，アシクロビルの高用量投与を行った新生児単純ヘルペスウイルス感染症の1例

A Case of Disseminated Neonatal Herpes Simplex Virus Infection Administered High-Dose Acyclovir and Evaluated by the Application of Real-Time PCR

藤田保健衛生大学　医学部　小児科

Department of Pediatrics, Fujita Health University School of Medicine

宮田昌史・加藤規子・竹内正知・水谷仁子・久保田真通・山﨑俊夫

Masafumi MIYATA，Noriko KATO，Masatomo TAKEUCHI， Hiroko MIZUTANI，Masamichi KUBOTA，Toshio YAMAZAKI

Key Words：acyclovir，neonatal herpes simplex virus infection，real-time polymerase chain reaction

　全身型単純ヘルペスウイルス（以下，HSV）感染症の新生児例をreal-time PCR（以下，RT PCR）法を用いて迅速診断した。髄液，末梢血単核球，気管支肺胞洗浄液のHSV-1 DNAが陽性で，アシクロビル（以下，ACV）を高用量（60mg/kg/分3/日）で投与し，経時的にRT PCR法で各検体のHSV-1 DNA量をモニタリングし，ACVの投与期間を決定した。全検体のHSV-1 DNAが陰性化したのは投与34日目だったためACV高用量投与が長期間になったが，好中球減少などの副作用は起こらなかった。退院後，生後3か月に神経学的後障害と考えられるてんかんを発症したが，1歳9か月での発達は正常である。

　Neonatal herpes simplex virus（HSV）infection is associated with high rates of mortality. Rapid diagnosis and adequate treatment are mandatory to improve the prognosis of the disease.
　We describe a case of neonate with disseminated HSV infection administered high-dose acyclovir（ACV）according to the result of the real-time polymerase chain reaction（RT PCR）.
　A 7-day-old boy was admitted to our hospital with dyspnea. HSV infection was suspected by hepatomegaly and the elevation of serum transaminase. RT PCR was applied to peripheral blood mononuclear cell, broncho-alveolar lavage fluid and cerebrospinal fluid, and HSV-1 DNA was rapidly detected from the all specimens. He was treated with high-dose acyclovir（60mg/kg/day）for 34 days according to the serial result of RT PCR assays. There was no side effect related to the therapy.
　After discharge, although he suffered from epilepsy on 3 months old, his mental and motor development is normal at 21 months old.