MENINGORADICULONEURITIS DUE TO ACYCLOVIR-RESISTANT VARICELLA-ZOSTER VIRUS IN AN ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME PATIENT

Varicella zoster virus (VZV) is recognized as one of the major viral p athogens reactivated in patients with the acquired immune deficiency s yndrome (AIDS). We report the case of meningoradiculoneuritis in an AI DS patient, associated with the isolation in the cerebrospinal fluid ( CSF) of a thymidine kinase (TK)-deficient, acyclovir (ACV)-resistant s train of VZV. Although the virus was sensitive in vitro to phosphonofo rmate (PFA), the patient did not improve during PFA therapy and finall y died. Several VZV strains isolated from this patient (including two isolates from the patient's CSF) were analyzed for their TK activity a nd subsequently the viral TK gene was sequenced showing a major deleti on leading to a truncated protein. Their susceptibility to several ant iviral agents including ACV, PFA, (E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU), 9-beta-D-arabinofuranosyladenine (vidarabine), (S)-1-(3-hydro xy-2-phosphonylmethoxypropyl) cytosine (HPMPC), and (S)-9-(3-hydroxy-2 -phosphonylmethoxypropyl)adenine (HPMPA) was evaluated. All the virus strains isolated from this patient remained sensitive to HPMPA and HPM PC, pointing to the potential usefulness of these acyclic nucleoside p hosphonates for the treatment of ACV-resistant VZV infections in immun ocompromised patients. (C) 1994 Wiley-Liss, Inc.