Adult herpes simplex encephalitis: Fifteen years’ experience

Riera‐Mestre, Antoni; Gubieras, L.; Martínez-Yélamos, Sergio; Cabellos, Carmen; Fernández-Viladrich, P

doi:10.1016/j.eimc.2008.05.006

Cited by 42 publications

(41 citation statements)

References 19 publications

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“…In different types of CNS infections, increasing age and lower GCS scores have long been known to be associated with poor outcomes (27)(28)(29). Our HME data were also in accordance with those regarding other infectious CNS disorders and with the initial reports of adult HME series (10,18,19).…”

Section: Discussionsupporting

confidence: 89%

“…Advanced age (10,18,19), lower GCS score (10), greater extent of brain involvement (20,21), low serum albumin level (18), longer duration of disease (20), delayed aciclovir use (18,19,(21)(22)(23)(24), the presence of red blood cells in the CSF (19), and immunosuppression (24) have been found to be associated with poorer outcomes in HME. In this study, we detected that a combination of therapeutic and host factors contributed to the outcomes in HME patients.…”

Section: Discussionmentioning

confidence: 99%

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Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Erdem

Çağ

Öztürk-Engin

et al. 2015

Antimicrob Agents Chemother

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Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Erdem

Çağ

Öztürk-Engin

et al. 2015

Antimicrob Agents Chemother

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“…Signs and symptoms of encephalitis then progress over the course of several days in most cases of HSVE [57,58]. The most common manifestations include encephalopathy, fever, seizures, headaches, and focal neurological deficits [57][58][59][60][61][62]. Although clinical features of HSVE have been well described in multiple large epidemiological studies, the clinical manifestations lack specificity.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

2016

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Herpetic infections have plagued humanity for thousands of years, but only recently have advances in antiviral medications and supportive treatments equipped physicians to combat the most severe manifestations of disease. Prompt recognition and treatment can be lifesaving in the care of patients with herpes simplex-1 virus encephalitis, the most commonly identified cause of sporadic encephalitis worldwide. Clinicians should be able to recognize the clinical signs and symptoms of the infection and familiarize themselves with a rational diagnostic approach and therapeutic modalities, as early recognition and treatment are key to improving outcomes. Clinicians should also be vigilant for the development of acute complications, including cerebral edema and status epilepticus, as well as chronic complications, including the development of autoimmune encephalitis associated with antibodies to the N-methyl-D-aspartate receptor and other neuronal cell surface and synaptic epitopes. Herein, we review the pathophysiology, differential diagnosis, and clinical and radiological features of herpes simplex virus-1 encephalitis in adults, including a discussion of the most common complications and their treatment. While great progress has been made in the treatment of this life-threatening infection, a majority of patients will not return to their previous neurologic baseline, indicating the need for further research efforts aimed at improving the long-term sequelae.

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“…2 In another cohort of 24 patients with PCR-confirmed HSV-E, WBC counts were normal in as many as 21%. 4 Whether the immune status in the current patient was of significance is unclear. One article reporting three cases suggested that there might be a relationship between abnormal presentation, normal CSF, and the immunological status of the patient.…”

mentioning

confidence: 92%

Herpes Simplex Virus Encephalitis Without Cerebrospinal Fluid Pleocytosis Is Not Unusual

Schoonman

Rath

Buren³

et al. 2012

J American Geriatrics Society

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is a rare but devastating disease with an incidence of approximately two to four people per 1 million. The initial presentation consists of subacute development of fever, altered consciousness, focal cranial nerve deficit, hemiparesis, and aphasia, but the clinical presentation is mild or atypical in as much as 20% of individuals, 1 and cerebrospinal fluid (CSF) without pleocytosis has been described during the first 2 days, 2 which could lead to diagnostic difficulties. In this journal, Mook-Kanamori and colleagues described an individual with a HSV encephalitis with abnormalities on the magnetic resonance imaging (MRI) scan of the brain without pleocytosis in the CSF during the initial examination. 3 They concluded that normal CSF is highly unusual. We present a patient with HSV-E with MRI abnormalities but no pleocytosis on repeated lumbar punctures and would like to argue that finding no pleocytosis is not unusual.A 72-year-old man was admitted to the internal medicine department of Haga Teaching Hospital (The Hague, the Netherlands) with fever, malaise, and respiratory symptoms. He had been diagnosed with Wegener's disease with pulmonary and renal involvement 4 months earlier for which he was treated with cyclophosphamide and prednisone in combination with cotrimoxazole, resulting in partial remission of his Wegener's disease after 3 months. At that time (1 month before admission) he developed asymptomatic severe leukopenia (0.8 9 10 9 WBC/L), which made it necessary to interrupt his immunosuppressive treatment. The leukopenia resolved, and leukocyte number was normalized at time of admission (8.2 9 10 9 WBC/L).In the week before admittance, his physical condition deteriorated, and he had shortness of breath after walking short distances, although on the day of admission, he was able to drive his car. He did not complain of headache. During his first night in the hospital, he had signs of progressive respiratory distress without signs of pneumonia on chest X-ray and was admitted to the intensive care unit the next morning. Because of respiratory failure, he was mechanically ventilated. Because there was no clear focus for the fever, a lumbar puncture was done that showed no abnormalities (total white cell blood count (WBC) 1/lL (reference: <4/lL), protein 0.45 g/L (reference: 0.26-0.79 g/L), glucose 4.00 mmol/L (reference: 2.50-3.70 mmol/L)). On the third and fourth days, a computed tomography (CT) scan of the brain and lungs was performed and did not show clear abnormalities. On the fifth day, sedation was temporarily stopped and, because he did not regain consciousness, an electroencephalogram (EEG) was performed that showed generalized epileptic discharges on the right more than on the left frontal region, suggesting nonconvulsive status epilepticus. The epilepsia was treated with diphantoine, levetiracetam, and midazolam. Eight days after admittance, CT scan of the brain was repeated and showed mild hypodensity over the right temporal region, suggesting edema. HSV-E was considered, and a second lumbar pu...

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Adult herpes simplex encephalitis: Fifteen years’ experience

Cited by 42 publications

References 19 publications

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Herpes Simplex Virus-1 Encephalitis in Adults: Pathophysiology, Diagnosis, and Management

Herpes Simplex Virus Encephalitis Without Cerebrospinal Fluid Pleocytosis Is Not Unusual

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