Uluhan Sili1, Abdurrahman Kaya2, Ali Mert3. 1. Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey. Electronic address: uluhan.sili@marmara.edu.tr. 2. Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey. 3. Department of Internal Medicine, Istanbul Medipol University School of Medicine, Istanbul, Turkey.
Abstract
BACKGROUND: Herpes simplex virus (HSV) is one of the most common causes of sporadic encephalitis worldwide. OBJECTIVE: We aimed to determine clinical characteristics and prognosis of HSV encephalitis (HSVE) cases reviewed retrospectively from several collaborating centers. STUDY DESIGN: We searched hospital archives of the last 10 years for patients with HSVE diagnosis, i.e. clinical presentation compatible with encephalitis and brain involvement on magnetic resonance imaging (MRI) and/or detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction (PCR). Clinical characteristics were noted and patients were phone-interviewed. HSVE cases were grouped and analyzed as proven and probable, based on virological confirmation by PCR. Univariate and multivariate analyses were used to determine factors associated with prognosis. RESULTS: A total of 106 patients (63 males and 43 females; mean age, 44 years; range, 18-83 years) were included. Most common symptoms were changes in mental status, fever, headache, and seizure. HSV PCR was positive in 69% of patients tested, while brain involvement was detected on MRI in 95%. Acyclovir was started mostly within five days of main symptom and continued for ≥14 days. Case fatality rate was 8%, while 69% of patients recovered with sequelae. Favorable prognosis was observed in 73% of patients. Multivariate analysis identified the duration of disease before hospital admission (odds ratio (OR)=1.24) and the extent of brain involvement on MRI at the time of admission (OR=37.22) as two independent risk factors associated with poor prognosis. CONCLUSIONS: Although HSVE fatality regressed considerably with acyclovir treatment, many patients survive with sequelae. Our results emphasize the importance of early diagnosis and prompt treatment of HSVE.
BACKGROUND: Herpes simplex virus (HSV) is one of the most common causes of sporadic encephalitis worldwide. OBJECTIVE: We aimed to determine clinical characteristics and prognosis of HSV encephalitis (HSVE) cases reviewed retrospectively from several collaborating centers. STUDY DESIGN: We searched hospital archives of the last 10 years for patients with HSVE diagnosis, i.e. clinical presentation compatible with encephalitis and brain involvement on magnetic resonance imaging (MRI) and/or detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction (PCR). Clinical characteristics were noted and patients were phone-interviewed. HSVE cases were grouped and analyzed as proven and probable, based on virological confirmation by PCR. Univariate and multivariate analyses were used to determine factors associated with prognosis. RESULTS: A total of 106 patients (63 males and 43 females; mean age, 44 years; range, 18-83 years) were included. Most common symptoms were changes in mental status, fever, headache, and seizure. HSV PCR was positive in 69% of patients tested, while brain involvement was detected on MRI in 95%. Acyclovir was started mostly within five days of main symptom and continued for ≥14 days. Case fatality rate was 8%, while 69% of patients recovered with sequelae. Favorable prognosis was observed in 73% of patients. Multivariate analysis identified the duration of disease before hospital admission (odds ratio (OR)=1.24) and the extent of brain involvement on MRI at the time of admission (OR=37.22) as two independent risk factors associated with poor prognosis. CONCLUSIONS: Although HSVE fatality regressed considerably with acyclovir treatment, many patients survive with sequelae. Our results emphasize the importance of early diagnosis and prompt treatment of HSVE.
Authors: Lianghua Bin; Michael G Edwards; Ryan Heiser; Joanne E Streib; Brittany Richers; Clifton F Hall; Donald Y M Leung Journal: J Allergy Clin Immunol Date: 2014-08-23 Impact factor: 10.793
Authors: P Jaquet; E de Montmollin; C Dupuis; C Sazio; M Conrad; V Susset; S Demeret; J M Tadie; L Argaud; F Barbier; B Sarton; R Chabane; D Daubin; N Brulé; N Lerolle; M Alves; D Da Silva; A El Kalioubi; S Silva; P Bailly; M Wolff; L Bouadma; J F Timsit; R Sonneville Journal: Intensive Care Med Date: 2019-07-10 Impact factor: 17.440
Authors: R Li; P-A Shi; T-F Liu; Y Li; Y Wang; K Wu; X-J Chen; H-F Xiao; Y-L Wang; L Ma; X Lou Journal: AJNR Am J Neuroradiol Date: 2019-10-24 Impact factor: 3.825