TY - JOUR
T1 - Management of suspected herpes simplex virus encephalitis in adults in a UK teaching hospital
AU - Bell, David J.
AU - Suckling, Ruth
AU - Rothburn, Michael M.
AU - Blanchard, Tom
AU - Stoeter, David
AU - Michael, Benedict
AU - Cooke, Richard P D
AU - Kneen, Rachel
AU - Solomon, Tom
PY - 2009
Y1 - 2009
N2 - 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. © Royal College of Physicians, 2009. All rights reserved.
AB - 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. © Royal College of Physicians, 2009. All rights reserved.
KW - Aciclovir
KW - Central nervous system infection
KW - Encephalitis
KW - Herpes simplex virus
KW - Lumbar puncture
UR - https://www.scopus.com/pages/publications/69049110102
M3 - Article
SN - 1470-2118
VL - 9
SP - 231
EP - 235
JO - Clinical Medicine, Journal of the Royal College of Physicians of London
JF - Clinical Medicine, Journal of the Royal College of Physicians of London
IS - 3
ER -