Results of a multinational study suggests rapid diagnosis and early onset of antiviral treatment in herpetic meningoencephalitis

• Published in: Antimicrobial agents and chemotherapy Vol. 59; no. 6; pp. 3084 - 3089
• Main Authors: Erdem, Hakan, Cag, Yasemin, Ozturk-Engin, Derya, Defres, Sylviane, Kaya, Selcuk, Larsen, Lykke, Poljak, Mario, Barsic, Bruno, Argemi, Xavier, Sørensen, Signe Maj, Bohr, Anne Lisbeth, Tattevin, Pierre, Gunst, Jesper Damsgaard, Baštáková, Lenka, Jereb, Matjaž, Somuncu Johansen, Isik, Karabay, Oguz, Pekok, Abdullah Umut, Sipahi, Oguz Resat, Chehri, Mahtab, Beraud, Guillaume, Shehata, Ghaydaa, Fontana del Vecchio, Rosa, Maresca, Mauro, Karsen, Hasan, Sengoz, Gonul, Sunbul, Mustafa, Yilmaz, Gulden, Yilmaz, Hava, Sharif-Yakan, Ahmad, Kanj, Souha, Parlak, Emine, Pehlivanoglu, Filiz, Korkmaz, Fatime, Komur, Suheyla, Kose, Sukran, Ulug, Mehmet, Bolukcu, Sibel, Coskuner, Seher Ayten, Ince, Nevin, Akkoyunlu, Yasemin, Halac, Gulistan, Sahin-Horasan, Elif, Tireli, Hulya, Kilicoglu, Gamze, Al-Mahdawi, Akram, Nemli, Salih Atakan, Inan, Asuman, Senbayrak, Seniha, Stahl, Jean Paul, Vahaboglu, Haluk
• Format: Journal Article
• Language: English
• Published: American Society for Microbiology 16.03.2015
• Subjects: Life Sciences; Microbiology and Parasitology
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/AAC.05016-14

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.