单纯疱疹病毒再感染的免疫治疗
长期以来都有观点认为免疫治疗(特别是皮质类固醇的使用)有助于治疗单纯疱疹病毒脑炎和单纯疱疹病毒-复发性脑炎。[66]Sköldenberg B, Aurelius E, Hjalmarsson A, et al. Incidence and pathogenesis of clinical relapse after herpes simplex encephalitis in adults. J Neurol. 2006;253:163-170.http://www.ncbi.nlm.nih.gov/pubmed/16222428?tool=bestpractice.com在使用阿昔洛韦前,首先用皮质类固醇进行治疗。[67]Habel AH, Brown JK. Dexamethasone in herpes-simplex encephalitis. Lancet. 1972;1:695.http://www.ncbi.nlm.nih.gov/pubmed/4125204?tool=bestpractice.com[68]Upton AR, Foster JB, Barwick DD. Dexamethasone treatment in herpes-simplex encephalitis. Lancet. 1971;1:861.http://www.ncbi.nlm.nih.gov/pubmed/4102550?tool=bestpractice.com已有出版物(包括回顾性分析)说明了皮质类固醇治疗单纯疱疹病毒脑炎的益处。[69]Kamei S, Sekizawa T, Shiota H, et al. Evaluation of combination therapy using aciclovir and corticosteroid in adult patients with herpes simplex virus encephalitis. J Neurol Neurosurg Psychiatry. 2005;76:1544-1549.http://jnnp.bmj.com/content/76/11/1544.longhttp://www.ncbi.nlm.nih.gov/pubmed/16227548?tool=bestpractice.comGACHE 试验开始于 2006 年,它是一项大型、多中心、随机、双盲、安慰剂对照性研究,研究者期望通过该研究能解答免疫治疗是否有益的疑问。[70]Martinez-Torres F, Menon S, Pritsch M, et al; GACHE Investigators. Protocol for German trial of acyclovir and corticosteroids in herpes-simplex-virus-encephalitis (GACHE): a multicenter, multinational, randomized, double-blind, placebo-controlled German, Austrian and Dutch trial [ISRCTN45122933]. BMC Neurol. 2008;8:40.https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-8-40http://www.ncbi.nlm.nih.gov/pubmed/18959773?tool=bestpractice.com预计将在今年内发表。
高滴度免疫球蛋白(西尼罗河病毒)
有建议提出用免疫球蛋白作为重度西尼罗病毒性感染的治疗方法,但迄今尚无定论。[71]Ben-Nathan D, Gershoni-Yahalom O, Samina I, et al. Using high titer West Nile intravenous immunoglobulin from selected Israeli donors for treatment of West Nile virus infection. BMC Infect Dis. 2009;9:18.https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-9-18http://www.ncbi.nlm.nih.gov/pubmed/19222853?tool=bestpractice.com
奥司他韦
如果疑似流感病毒感染,可考虑使用。