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Multicenter Study
. 2015;59(6):3084-9.
doi: 10.1128/AAC.05016-14. Epub 2015 Mar 16.

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

Hakan Erdem  1 , Yasemin Cag  2 , Derya Ozturk-Engin  3 , Sylviane Defres  4 , Selcuk Kaya  5 , Lykke Larsen  6 , Mario Poljak  7 , Bruno Barsic  8 , Xavier Argemi  9 , Signe Maj Sørensen  10 , Anne Lisbeth Bohr  11 , Pierre Tattevin  12 , Jesper Damsgaard Gunst  13 , Lenka Baštáková  14 , Matjaž Jereb  15 , Isik Somuncu Johansen  6 , Oguz Karabay  16 , Abdullah Umut Pekok  17 , Oguz Resat Sipahi  18 , Mahtab Chehri  19 , Guillaume Beraud  20 , Ghaydaa Shehata  21 , Rosa Fontana Del Vecchio  22 , Mauro Maresca  22 , Hasan Karsen  23 , Gonul Sengoz  24 , Mustafa Sunbul  25 , Gulden Yilmaz  26 , Hava Yilmaz  25 , Ahmad Sharif-Yakan  27 , Souha Shararah Kanj  27 , Emine Parlak  28 , Filiz Pehlivanoglu  24 , Fatime Korkmaz  29 , Suheyla Komur  30 , Sukran Kose  31 , Mehmet Ulug  32 , Sibel Bolukcu  3 , Seher Ayten Coskuner  33 , Nevin Ince  34 , Yasemin Akkoyunlu  35 , Gulistan Halac  36 , Elif Sahin-Horasan  37 , Hulya Tireli  38 , Gamze Kilicoglu  39 , Akram Al-Mahdawi  40 , Salih Atakan Nemli  41 , Asuman Inan  3 , Seniha Senbayrak  3 , Jean Paul Stahl  42 , Haluk Vahaboglu  43
Affiliations
Multicenter Study

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

Hakan Erdem et al. Antimicrob Agents Chemother. 2015.

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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Figures

FIG 1
FIG 1
Predictions (Pr, probability) of antiviral treatment timing for unfavorable outcome. The data are presented as the mean values with the 95% CI.
FIG 2
FIG 2
Observed outcomes against predicted outcomes estimated by the model.
FIG 3
FIG 3
Predictive margins of age and Glasgow Coma Scale score on unfavorable outcome. The data are presented as the mean values with the 95% CI.
See this image and copyright information in PMC

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