Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis

Erdem, Hakan and Cag, Yasemin and Ozturk-Engin, Derya and Defres, Sylviane and Kaya, Selcuk and Larsen, Lykke and Poljak, Mario and Baršić, Bruno and Argemi, Xavier and Sørensen, Signe Maj and Bohr, Anne Lisbeth and Tattevin, Pierre and Gunst, Jesper Damsgaard and Baštáková, Lenka and Jereb, Matjaž and Johansen, Isik Somuncu and Karabay, Oguz and Pekok, Abdullah Umut and Sipahi, Oguz Resat and Chehri, Mahtab and Beraud, Guillaume and Shehata, Ghaydaa and Del Vecchio, Rosa Fontana and Maresca, Mauro and Karsen, Hasan and Sengoz, Gonul and Sunbul, Mustafa and Yilmaz, Gulden and Yilmaz, Hava and Sharif-Yakan, Ahmad and Kanj, Souha Shararah and Parlak, Emine and Pehlivanoglu, Filiz and Korkmaz, Fatime and Komur, Suheyla and Kose, Sukran and Ulug, Mehmet and Bolukcu, Sibel and Coskuner, Seher Ayten and Ince, Nevin and Akkoyunlu, Yasemin and Halac, Gulistan and Sahin-Horasan, Elif and Tireli, Hulya and Kilicoglu, Gamze and Al-Mahdawi, Akram and Nemli, Salih Atakan and Inan, Asuman and Senbayrak, Seniha and Stahl, Jean Paul and Vahaboglu, Haluk (2015) Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis. Antimicrobial Agents and Chemotherapy, 59 (6). pp. 3084-3089. ISSN 0066-4804

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Abstract

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.

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