Treatment of varicella-zoster meningoencephalitis with acyclovir--demonstration of virus in cerebrospinal fluid by electron microscopy.

Disseminated varicella-zoster (V-Z) infection developed in three immunocompromised patients, with direct invasion of the central nervous system by virus. For two of these patients, diagnosis was confirmed by electron microscopic examination of cerebrospinal fluid (CSF) and detection of viral particles. Extensive immunologic evaluation demonstrated impairment of cellular immune function. All were treated with acyclovir at a dose of 1,500 mg/m2/day for 5-7 days. Peak and trough plasma levels of this antiviral agent were monitored during the course of therapy and were shown to be well above V-Z virustatic levels. Clinical response was noted by the third day of therapy. Vesicles and CSF were culture negative at termination of treatment. Administration of this high dose of acyclovir was not associated with hematologic, immunologic, hepatic, renal, or gastrointestinal toxicity as judged by frequent laboratory and clinical evaluation.