Outcome of and Prognostic Factors for Herpes Simplex Encephalitis in Adult Patients: Results of a Multicenter Study

• Published in: Clinical infectious diseases Vol. 35; no. 3; pp. 254 - 260
• Main Authors: Raschilas, Franck, Wolff, Michel, Delatour, Frédérique, Chaffaut, Cendrine, De Broucker, Thomas, Chevret, Sylvie, Lebon, Pierre, Canton, Philippe, Rozenberg, Flore
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.08.2002; University of Chicago Press
• Subjects: Acyclovir - therapeutic use; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents - therapeutic use; Antivirals; Biological and medical sciences; Brain - diagnostic imaging; Brain - virology; Disabilities; Encephalitis, Herpes Simplex - diagnosis; Encephalitis, Herpes Simplex - diagnostic imaging; Encephalitis, Herpes Simplex - drug therapy; Encephalitis, Herpes Simplex - physiopathology; Female; Glasgow coma scale; Health outcomes; Herpes simplex encephalitis; Hospital admissions; Human viral diseases; Humans; Infectious diseases; Major Articles; Male; Medical sciences; Middle Aged; Multicenter Studies as Topic; Multivariate Analysis; Nervous system diseases; Polymerase chain reaction; Prognosis; Radiography; Retrospective Studies; Simplexvirus; Treatment Outcome; Viral diseases; Viral diseases of the nervous system; Human; Encephalitis; Nervous system diseases; Prognosis; Herpesviridae; Multicenter study; Alphaherpesvirinae; Cerebral disorder; Infection; Virus; Viral disease; Central nervous system disease; Risk factor; Adult; Herpesvirus hominis; Predictive factor
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1086/341405

Management of herpes simplex encephalitis (HSE) has been considerably improved by the availability of acyclovir therapy and rapid polymerase chain reaction (PCR)—based diagnostic assays. Prognostic factors for this rare affliction are, however, misestimated. We conducted a large retrospective multicenter study that included 93 adult patients in whom HSE was diagnosed by PCR from 1991 through 1998 and who were treated with intravenous acyclovir. Among the 85 patients assessed at 6 months, 30 (35%) had a poor outcome, which led to death in 13 patients (15%) and severe disability in 17 (20%). The outcome was favorable for 55 patients (65%). A multivariate analysis identified 2 factors that were found to be independently associated with poor outcome: a Simplified Acute Physiology Score II ⩾27 at admission and a delay of >2 days between admission to the hospital and initiation of acyclovir therapy. Early administration of antiviral therapy is the only parameter that can be modified to improve the prognosis of patients with HSE.