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

Authors	ERDEM Hakan CAG Yasemin OZTURK-ENGIN Derya DEFRES Sylviane KAYA Selcuk LARSEN Lykke POLJAK Mario BARSIC Bruno ARGEMI Xavier SORENSEN Signe Maj BOHR Anne Lisbeth TATTEVIN Pierre GUNST Jesper Damsgaard BAŠTÁKOVÁ Lenka JEREB Matjaž JOHANSEN Isik Somuncu KARABAY Oguz PEKOK Abdullah Umut SIPAHI Oguz Resat CHEHRI Mahtab BERAUD Guillaume SHEHATA Ghaydaa DEL VECCHIO Rosa Fontana MARESCA Mauro KARSEN Hasan SENGOZ Gonul SUNBUL Mustafa YILMAZ Gulden YILMAZ Hava SHARIF-YAKAN Ahmad KANJ Souha Shararah 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-MANDAWI Akram NEMLI Salih Atakan INAN Asuman SENBAYRAK Seniha STAHL Jean Paul VAHABOGLU Haluk
Year of publication	2015
Type	Article in Periodical
Magazine / Source	Antimicrobial Agents and Chemotherapy
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1128/AAC.05016-14
Field	Epidemiology, infectious diseases and clinical immunology
Keywords	CENTRAL-NERVOUS-SYSTEM; SIMPLEX ENCEPHALITIS; BACTERIAL-MENINGITIS; PRACTICE GUIDELINES; ADULT PATIENTS; ACYCLOVIR; MANAGEMENT; INFECTIONS; MANIFESTATIONS; MULTICENTER
Description	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.