Abbuehl Lena S, Hofmann Eveline, Hakim Arsany, Dietmann Anelia
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Front Neurol. 2023 Jun 26;14:1130090. doi: 10.3389/fneur.2023.1130090. eCollection 2023.
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most commonly diagnosed infectious causes of sporadic encephalitis worldwide. Despite treatment, mortality and morbidity rates remain high, especially for HSV encephalitis. This review is intended to provide an overview of the existing scientific literature on this topic from the perspective of a clinician who is confronted with serious decisions about continuation or withdrawal of therapeutic interventions. We performed a literature review searching two databases and included 55 studies in the review. These studies documented or investigated specifically outcome and predictive parameters of outcome of HSV and/or VZV encephalitis. Two reviewers independently screened and reviewed full-text articles meeting the inclusion criteria. Key data were extracted and presented as a narrative summary. Both, HSV and VZV encephalitis have mortality rates between 5 and 20% and complete recovery rates range from 14 to 43% for HSV and 33 to 49% for VZV encephalitis. Prognostic factors for both VZV and HSV encephalitis are older age and comorbidity, as well as severity of disease and extent of magnetic resonance imaging (MRI) lesions on admission, and delay in treatment initiation for HSV encephalitis. Although numerous studies are available, the main limiting factors are the inconsistent patient selection and case definitions as well as the non-standardised outcome measures, which hampers the comparability of the studies. Therefore, larger and standardised observational studies applying validated case definitions and outcome measures including quality of life assessment are required to provide solid evidence to answer the research question.
单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）是全球范围内散发性脑炎最常见的确诊感染病因。尽管进行了治疗，但死亡率和发病率仍然很高，尤其是HSV脑炎。本综述旨在从面临关于继续或停止治疗干预的严肃决策的临床医生角度，概述有关该主题的现有科学文献。我们进行了文献综述，检索了两个数据库，纳入了55项研究。这些研究记录或专门调查了HSV和/或VZV脑炎的结局及结局预测参数。两名审阅者独立筛选并审阅了符合纳入标准的全文文章。提取关键数据并以叙述性总结的形式呈现。HSV和VZV脑炎的死亡率均在5%至20%之间，HSV脑炎的完全康复率为14%至43%，VZV脑炎为33%至49%。VZV和HSV脑炎的预后因素包括年龄较大、合并症、疾病严重程度、入院时磁共振成像（MRI）病变范围以及HSV脑炎治疗开始延迟。尽管有大量研究，但主要限制因素是患者选择和病例定义不一致以及结局测量不标准化，这妨碍了研究的可比性。因此，需要开展更大规模且标准化的观察性研究，采用经过验证的病例定义和结局测量方法，包括生活质量评估，以提供确凿证据来回答研究问题。
