Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Jun;9(3):231-5.
doi: 10.7861/clinmedicine.9-3-231.

Management of suspected herpes simplex virus encephalitis in adults in a U.K. teaching hospital

David J Bell  1 , Ruth Suckling, Michael M Rothburn, Tom Blanchard, David Stoeter, Benedict Michael, Richard P D Cooke, Rachel Kneen, Tom Solomon
Affiliations

Management of suspected herpes simplex virus encephalitis in adults in a U.K. teaching hospital

David J Bell et al. Clin Med (Lond). 2009 Jun.

Abstract

The outcome of herpes simplex virus (HSV) encephalitis is improved with prompt initiation of aciclovir treatment. Delays are common, but there is little understanding of why they occur. The case notes of 21 adults admitted with suspected HSV encephalitis over one year were reviewed. The median (range) duration of illness was 2.5 (1-99) days. Seventeen (81%) patients had a lumbar puncture (LP) performed, at a median (range) time of 24 (2-114) hours after encephalitis was suspected. Lumbar puncture was delayed for a computed tomography (CT) scan in 15 patients, but only one of these had contraindications to an immediate LP. The median (range) time from presentation to starting aciclovir was 48 (2-432) hours. HSV-PCR (polymerase chain reaction) was requested on cerebrospinal fluid from 12 patients, one of whom was positive. Five (24%) patients were given the wrong dose of aciclovir. Overall the management of suspected HSV encephalitis was often sub-optimal, with delays in LP occurring due to unnecessary CT scans, and the wrong aciclovir dose administered. Guidelines for the management of suspected encephalitis are needed.

PubMed Disclaimer

Comment in

References

    1. Whitley RJ. Herpes simplex encephalitis: adolescents and adults. Antiviral Res 2006; 71:141–8.10.1016/j.antiviral.2006.04.002 - DOI - PubMed
    1. Raschilas F, Wolff M, Delatour F. et al Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis 2002; 35:254–60.10.1086/341405 - DOI - PubMed
    1. Fodor PA, Levin MJ, Weinberg A. et al Atypical herpes simplex virus encephalitis diagnosed by PCR amplification of viral DNA from CSF. Neurology 1998; 51:554–9.10.1212/WNL.51.2.554 - DOI - PubMed
    1. Skoldenberg B, Forsgren M, Alestig K. et al Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet 1984; 2:707–11. - PubMed
    1. Whitley RJ, Alford CA, Hirsch MS. et al Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med 1986; 314: 144–9.10.1056/NEJM198601163140303 - DOI - PubMed

MeSH terms