急性末梢性顔面神経麻痺における水痘帯状庖疹ウイルス感染の早期診断

皮内反応と髄液検査の意義

抄録

In the early stage of acute facial paralysis, proving the presence of a viral infection has important therapeutic as well as prognostic implications.
We have already known that a significant increase of serum complement fixation (CF) antibody titer of the varicella-zoster virus (VZV) appears in 20 to 30% of Bell's palsy cases. However, it is difficult to say that the most common method of diagnosing a viral infection, by measuring the amount of serum CF antibody titer, is rapid, bacause it takes more than 2 or 3 weeks to reach a final conclusion. Recently, Takahashi⁶⁾ reported a new procedure for diagnosing VZZ infection by using a skin test with VZV antigen. This procedure may permit us to succeed in the early diagnosis of a VZV infection. On the other hand, we know that Hunt's syndrome has some influence on the cerebrospinal fluid (CSF), especially in the early stage of the disease. We studied
100 patients with acute peripheral facial paralysis by using both the VZV antigen skin test and the examination of the CSF, within 2 weeks after onset of paralysis. The purpose of this roport is to show the results of these two procedures and to point out their usefulness in the early diagnosis of VZV infection in patients with acute peripheral facial paralysis. The results obtained were as follows.
1) By using VZV antigen skin test, the ratios of early diagnosis of VZV infection were shown in each diseases, as 85.4% in Hunt's syndrome, 58.3% in zoster sine herpete and 72.3% in Bell's palsy. It was indicated that this procedure is valuable for early diagnosis of VZV infection in these patients.
2) In 73.2% of the patients with Hunt's syndrome and 66.7% of with zoster sine herpete, it was possible to detect increased cell counts (mainly monocyte) in the CSF. This is in marked contrast to Bell's palsy, as only 8.5% of these subjects were noted to have increased cell counts (mainly monocyte). By examining cell counts of CSF, it is possible to diagnose a high incidence of viral infections among facial nerve paralysis.
3) By carrying out both of skin test with VZV antigen and CSF examinations, 12 out of 59 patients who had been diagnosed as Bell's palsy in their early stage of paralysis were diagnosed to have VZV infection before significant increase of anti-VZV CF antibody titer were detected in the sera.