Marine Mulatero1, Mohamed Boucekine2, Olivier Felician3,4, Salah Boussen5, Gilles Kaplanski1, Pascal Rossi6, Philippe Parola7, Andréas Stein7, Philippe Brouqui7, Jean Christophe Lagier7, Marc Leone8, Elsa Kaphan9. 1. Service de Médecine Interne, CHU Conception, Assistance Publique Hôpitaux de Marseille, 147 Boulevard Baille, 13385, Marseille Cedex 5, France. 2. Aix-Marseille Univ, Faculté de Médecine, Secteur Timone, EA 3279: CEReSS, Centre d'Etude Et de Recherche Sur Les Services de Santé Et La Qualité de Vie, 27 Boulevard Jean Moulin, 13005, Marseille, France. 3. Service de Neuropsychologie, CHU Timone, Assistance Publique Hôpitaux de Marseille, Pôle de Neurosciences Cliniques, Marseille, France. 4. Aix-Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France. 5. Service d'Anesthésie-Réanimation, CHU Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. 6. Service de Médecine Interne, CHU Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France. 7. Institut Hospitalo-Universitaire Méditerranée Infection, CHU Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France. 8. Département de Réanimation, CHU Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France. 9. Service de Médecine Interne, CHU Conception, Assistance Publique Hôpitaux de Marseille, 147 Boulevard Baille, 13385, Marseille Cedex 5, France. elsa.kaphan@ap-hm.fr.
Abstract
BACKGROUND: Prognosis of herpetic encephalitis remains severe, with a high proportion of deaths and sequelae. Its treatment is based on acyclovir, but the precise and most effective modalities of this treatment are not established. The objective of this study was to determine them. METHODS: For this, we carried out a descriptive, retrospective, monocentric study, using the current coding database at Marseille University Hospitals. Cohort was intended to be exhaustive for the disease, from January 2000 to June 2019, including patients hospitalized in intensive care and conventional hospitalization sector. Patients (n = 76) included were at least 16 years of age and had a clinical presentation, cerebral Magnetic Resonance Imaging, and/or electroencephalogram abnormalities consistent with herpetic encephalitis confirmed by a positive HSV-PCR in the CSF. Clinical data and treatment, including the doses actually administered to the patient, were compared according to patient's outcome. RESULTS: The mortality rate was 12%, whereas 49% had complete recovery and 39% sequelae impeding independence. Poor outcome was statistically associated with persistence of confusion, aphasia, and impaired consciousness lasting more than 5 days, superinfection, status epilepticus, and length of stay in intensive care unit. A statistical decision tree, constructed using the Classification And Regression Tree model, to prioritize treatment management, showed two main factors that influence the outcome: the patient's weight, and the average daily acyclovir dose actually administered. CONCLUSION: These results suggest to modify acyclovir management in herpetic encephalitis, for low-weight patients (< 79 kg) with a minimum dosage of 2550 mg/day (850 mg/ 8 h), when possible.
BACKGROUND: Prognosis of herpetic encephalitis remains severe, with a high proportion of deaths and sequelae. Its treatment is based on acyclovir, but the precise and most effective modalities of this treatment are not established. The objective of this study was to determine them. METHODS: For this, we carried out a descriptive, retrospective, monocentric study, using the current coding database at Marseille University Hospitals. Cohort was intended to be exhaustive for the disease, from January 2000 to June 2019, including patients hospitalized in intensive care and conventional hospitalization sector. Patients (n = 76) included were at least 16 years of age and had a clinical presentation, cerebral Magnetic Resonance Imaging, and/or electroencephalogram abnormalities consistent with herpetic encephalitis confirmed by a positive HSV-PCR in the CSF. Clinical data and treatment, including the doses actually administered to the patient, were compared according to patient's outcome. RESULTS: The mortality rate was 12%, whereas 49% had complete recovery and 39% sequelae impeding independence. Poor outcome was statistically associated with persistence of confusion, aphasia, and impaired consciousness lasting more than 5 days, superinfection, status epilepticus, and length of stay in intensive care unit. A statistical decision tree, constructed using the Classification And Regression Tree model, to prioritize treatment management, showed two main factors that influence the outcome: the patient's weight, and the average daily acyclovir dose actually administered. CONCLUSION: These results suggest to modify acyclovir management in herpetic encephalitis, for low-weight patients (< 79 kg) with a minimum dosage of 2550 mg/day (850 mg/ 8 h), when possible.
Authors: Javier Riancho; Manuel Delgado-Alvarado; Maria Jose Sedano; Jose Miguel Polo; Jose Berciano Journal: Neurol Sci Date: 2013-06-19 Impact factor: 3.307