Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.
J Clin Virol. 2014 Jun;60(2):112-8. doi: 10.1016/j.jcv.2014.03.010. Epub 2014 Mar 25.
Herpes simplex virus (HSV) is one of the most common causes of sporadic encephalitis worldwide.
We aimed to determine clinical characteristics and prognosis of HSV encephalitis (HSVE) cases reviewed retrospectively from several collaborating centers.
We searched hospital archives of the last 10 years for patients with HSVE diagnosis, i.e. clinical presentation compatible with encephalitis and brain involvement on magnetic resonance imaging (MRI) and/or detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction (PCR). Clinical characteristics were noted and patients were phone-interviewed. HSVE cases were grouped and analyzed as proven and probable, based on virological confirmation by PCR. Univariate and multivariate analyses were used to determine factors associated with prognosis.
A total of 106 patients (63 males and 43 females; mean age, 44 years; range, 18-83 years) were included. Most common symptoms were changes in mental status, fever, headache, and seizure. HSV PCR was positive in 69% of patients tested, while brain involvement was detected on MRI in 95%. Acyclovir was started mostly within five days of main symptom and continued for ≥14 days. Case fatality rate was 8%, while 69% of patients recovered with sequelae. Favorable prognosis was observed in 73% of patients. Multivariate analysis identified the duration of disease before hospital admission (odds ratio (OR)=1.24) and the extent of brain involvement on MRI at the time of admission (OR=37.22) as two independent risk factors associated with poor prognosis.
Although HSVE fatality regressed considerably with acyclovir treatment, many patients survive with sequelae. Our results emphasize the importance of early diagnosis and prompt treatment of HSVE.
单纯疱疹病毒（HSV）是全球散发脑炎的最常见病因之一。
我们旨在确定从几个合作中心回顾性审查的单纯疱疹脑炎（HSVE）病例的临床特征和预后。
我们在过去 10 年中搜索了医院档案，以寻找诊断为 HSVE 的患者，即与脑炎一致的临床表现以及磁共振成像（MRI）上的脑实质受累和/或聚合酶链反应（PCR）检测到脑脊液中的 HSV DNA。记录了临床特征，并通过电话对患者进行了访谈。根据 PCR 对病毒学的确认，HSVE 病例分为确诊和可能病例，并进行了分组分析。采用单变量和多变量分析确定与预后相关的因素。
共纳入 106 例患者（63 例男性和 43 例女性；平均年龄 44 岁；范围 18-83 岁）。最常见的症状是精神状态改变、发热、头痛和癫痫发作。在接受检测的患者中，HSV PCR 阳性率为 69%，而 MRI 上显示脑实质受累的患者为 95%。阿昔洛韦大多在主要症状出现后 5 天内开始使用，并持续使用≥14 天。死亡率为 8%，69%的患者留有后遗症恢复。73%的患者预后良好。多变量分析确定在入院前疾病的持续时间（优势比（OR）=1.24）和入院时 MRI 上脑实质受累的程度（OR=37.22）是与预后不良相关的两个独立危险因素。
尽管阿昔洛韦治疗使 HSVE 的死亡率大大降低，但许多患者仍留有后遗症。我们的研究结果强调了早期诊断和及时治疗 HSVE 的重要性。
