RASCHILAS F, WOLFF M, DELATOUR F, DE BROUCKER T, LEBON P, ROZENBERG F; Interscience Conference on Antimicrobial Agents and Chemotherapy (41st : 2001 : Chicago, Ill.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2001 Dec 16-19; 41: abstract no. L-1973.
Hopital Louis Mourier, Colombes, France
BACKGROUND: HSE is one of the most common and serious sporadic encephalitis of immunocompetent adults.PCR detection of HSV DNA in the cerebrospinal fluid and acyclovir (ACV) therapy are currently two standards in the management of patients with HSE. Only few studies were specifically designed to identify early prognostic factors of poor outcome. METHODS: We conducted a retrospective multicenter study of 93 adult patients with HSE diagnosed by PCR between 1991 and 1998. All patients were treated with intravenous ACV. Parameters associated with outcome were identified by multivariate analysis. RESULTS: The main characteristics of the patients at admission were: age: 53 +/- 17 years, SAPS II: 28 +/- 17, Glasgow coma score (GCS): 14 +/- 3, seizures: 31 (33%), focal neurological abnormalities: 64 (69%). Overall, 66 patients (71%) were referred to the ICU (GCS at ICU admission: 11 +/- 3). The mean time from admission to the hospital and the start of ACV was 2 +/- 2.7 days (range: 0-15 days). The mean duration of ACV therapy was 18 +/- 6 days. Among the 84 evaluable patients between 6 month and 1 year, 30 (36%) had a poor outcome defined as death in 15 (18%) or severe sequelae in 15 (18%). In contrast, outcome was considered as good in 54 cases (64%): complete recovery: 13 (15%), minimal sequelae: 17 (20%), mild sequelae: 24 (28.5%. By multivariate analysis, 2 factors were independently associated with poor outcome, namely a SAPS II > 27 (OR: 3.7, CI95%: 1.3-10.6, p = 0.014), and an interval between admission and the start of ACV therapy longer than 2 days (OR: 3.1, CI95%: 1.1-9.1, p = 0.037). CONCLUSION: HSE in adult patients still induces high mortality and morbidity rates. To ensure the best outcome, antiviral therapy should be initiated as soon as possible when the diagnosis of HSE is suspected.
Publication Types:
Keywords:
- Acyclovir
- Adult
- Aged
- Antiviral Agents
- Contrast Media
- Encephalitis
- Encephalitis, Herpes Simplex
- Humans
- Polymerase Chain Reaction
- Retrospective Studies
- Seizures
- Simplexvirus
Other ID:
UI: 102269006
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