Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis
Open accessAbstract
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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- Authors
- Erdem, H., Cag, Y., Ozturk-Engin, D., Defres, S., Kaya, S., Larsen, L., Poljak, M., Barsic, B., Argemi, X., Sørensen, S. M., Bohr, A. L., Tattevin, P., Gunst, J. D., Baštáková, L., Jereb, M., Johansen, I. S., Karabay, O., Pekok, A. U., Sipahi, O. R., Chehri, M., Beraud, G., Shehata, G., Del Vecchio, R. F., Maresca, M., Karsen, H., Sengoz, G., Sunbul, M., Yilmaz, G., Yilmaz, H., Sharif-Yakan, A., Kanj, S. S., Parlak, E., Pehlivanoglu, F., Korkmaz, F., Komur, S., Kose, S., Ulug, M., Bolukcu, S., Coskuner, S. A., Ince, N., Akkoyunlu, Y., Halac, G., Sahin-Horasan, E., Tireli, H., Kilicoglu, G., Al-Mahdawi, A., Nemli, S. A., Inan, A., Senbayrak, S., Stahl, J. P., & Vahaboglu, H.
- Affiliations
- GATA Haydarpaşa Eğitim Hastanesi (TR)
- Dr. Lutfi Kirdar Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
- Haydarpaşa Numune Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
- University of Liverpool (GB)
- Karadeniz Technical University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
- Odense University Hospital (DK)
- University of Ljubljana (SI)
- Dr. Fran Mihaljevic University Hospital for Infectious Diseases, Department of Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
- Hôpital Civil, Strasbourg (FR)
- Aalborg University Hospital (DK)
- Copenhagen University Hospital (DK)
- Hôpital Pontchaillou (FR)
- Aarhus University Hospital (DK)
- Masaryk University (CZ)
- Ljubljana University Medical Centre (SI)
- Odense University Hospital, Department of Infectious Diseases Q, Odense, Denmark
- Sakarya University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
- Private Erzurum Sifa Hospital, Department of Infectious Diseases and Clinical Microbiology, Erzurum, Turkey
- Ege University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
- Hvidovre Hospital (DK)
- Poitiers University Hospital, Department of Infectious Diseases, Poitiers, France
- Assiut University Hospitals (EG)
- University of Catania, Section of Infectious Diseases, Department of Clinical and Molecular Biomedicine, Catania, Italy
- University of Catania (IT)
- Harran University (TR)
- Haseki Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
- Ondokuz Mayis University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Samsun, Turkey
- Ankara University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
- American University of Beirut Medical Center (LB)
- American University of Beirut Medical Center, Beirut, Lebanon
- Atatürk University (TR)
- Konya Eğitim ve Araştırma Hastanesi (TR)
- Cukurova University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkey
- Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
- Private Umit Hospital, Department of Infectious Diseases and Clinical Microbiology, Eskisehir, Turkey
- İzmir Bozyaka Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
- Düzce University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Konuralp, Düzce, Turkey
- Bezmiâlem Vakıf Üniversitesi (TR)
- Bezmi Alem Vakif University, School of Medicine, Department of Neurology, Istanbul, Turkey
- Mersin University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mersin, Turkey
- Haydarpaşa Numune Training and Research Hospital, Department of Neurology, Istanbul, Turkey
- Haydarpaşa Numune Eğitim ve Araştırma Hastanesi (TR)
- Department of Neurology, Baghdad Teaching Hospital, Baghdad, Iraq
- Izmir Kâtip Çelebi University (TR)
- Université Joseph Fourier (FR)
- Medeniyet University, Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
- ORCID
- Venue
- Antimicrobial Agents and Chemotherapy
- Publisher
- American Society for Microbiology
- Published
- 2015-06
- Volume
- 59
- Issue
- 6
- Pages
- 3084-3089
- ISSN
- 0066-4804 (ISSN-L)
- 1098-6596
- PMC
- PMC4432209
- OpenAlex
- W1558272955
- Semantic Scholar
- 468577e2ff706e9f486c15802e977e85e1f4cec4
- Cited by
- 74
- References
- 35
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 8 · 2023: 5 · 2022: 2 · 2021: 4 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 13 · 2016: 6 · 2015: 3
- FWCI
- 7.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Antimicrobial Agents and Chemotherapy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Dr Med - University of Zagreb School of Medicine Digital Repository (acceptedVersion)
- Sakarya Üniversitesi Kurumsal Açık Akademik Arşivi (submittedVersion)
- HAL (submittedVersion)
- DSpace - Düzce (Duzce University) (submittedVersion, cc-by-nc-nd)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Keywords
- antiviral treatment timing, early antiviral therapy, prognostic factors, unfavorable outcome, mortality, sequelae, age, Glasgow Coma Scale, herpes simplex virus
- MeSH terms
- Adult, Antiviral Agents, Female, Humans, Male, Middle Aged, Retrospective Studies, Confidence Intervals, Treatment Outcome, Encephalitis, Herpes Simplex
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