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Delays in Initiation of Acyclovir Therapy in Herpes Simplex Encephalitis

Published online by Cambridge University Press:  02 December 2014

Peter S. Hughes  and
Alan C. Jackson
Peter S. Hughes
Affiliation:
Department of Internal Medicine (Neurology), University of Manitoba, Winnipeg, Manitoba, Canada
Alan C. Jackson*
Affiliation:
Department of Internal Medicine (Neurology), University of Manitoba, Winnipeg, Manitoba, Canada Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
*
Health Sciences Centre, GF-543, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada. Email: [email protected]
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Abstract

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Background:

Diagnosis of herpes simplex encephalitis (HSE) is based on clinical findings, MRI, and detection of herpes simplex virus (HSV) DNA in cerebrospinal fluid (CSF) using polymerase chain reaction amplification. Delays in starting treatment are associated with poorer clinical outcomes. We assessed the timing of initiation of acyclovir therapy in HSE.

Methods:

Inpatient databases from seven hospitals in Winnipeg, Manitoba were used to identify individuals diagnosed with encephalitis and HSE from 2004 to 2009. The time taken to initiate therapy with acyclovir and the reasons for delays were determined.

Results:

Seventy-seven patients were identified; 69 (90%) received acyclovir; in the others a non-HSV infection was strongly suspected. Thirteen patients were subsequently confirmed to have HSE. Acyclovir was initiated a median of 21 hours (3-407) after presentation in encephalitis cases, and a median of 11 hours (3-118) in HSE. The most common reason for delay was a failure to consider HSE in the differential diagnosis, despite suggestive clinical features. Where therapy was delayed in HSE patients, the decision to begin acyclovir was prompted by transfer of the patient to a different service (55%), recommendations by consultants (18%), imaging results (18%), and CSF pleocytosis (9%).

Conclusions:

Delays in initiating acyclovir for HSE are common, and are most often due to a failure to consider HSE in a timely fashion on presentation. In order to improve patient outcomes, physicians should be more vigilant for HSE, and begin acyclovir therapy expeditiously on the basis of clinical suspicion rather than waiting for confirmatory tests.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 5 , September 2012 , pp. 644 - 648
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1.Cinque, P, Cleator, GM, Weber, T, Monteyne, P, Sindic, CJ, Van Loon, AM.The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report. The EU Concerted Action on Virus Meningitis and Encephalitis. J Neurol Neurosurg Psychiatry. 1996;61:339–45.Google Scholar
2.Whitley, RJ, Soong, SJ, Linneman, C, et al.Herpes simplex encephalitis: clinical assessment. JAMA. 1982;247:317–20.Google Scholar
3.Baringer, JR.Herpes simplex infections of the nervous system. Neurol Clin. 2008;26:657–74.CrossRefGoogle ScholarPubMed
4.Whitley, RJ, Soong, SJ, Dolin, R, et al.Adenine arabinoside therapy of biopsy-proved herpes simplex encephalitis: National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study. N Engl J Med. 1977;297:289–94.CrossRefGoogle ScholarPubMed
5.Kimberlin, DW.Management of HSV encephalitis in adults and neonates: diagnosis, prognosis and treatment. Herpes. 2007;14:11–16.Google ScholarPubMed
6.Tyler, KL.Update on herpes simplex encephalitis. Rev Neurol Dis. 2004;1:169–78.Google Scholar
7.Kennedy, PG.Viral encephalitis. J Neurol. 2005;252:268–72.Google Scholar
8.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.Google Scholar
9.McGrath, N, Anderson, NE, Croxson, MC, Powell, KF.Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry. 1997;63:321–6.Google Scholar
10.Tunkel, AR, Glaser, CA, Bloch, KC, et al.The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47:303–27.CrossRefGoogle ScholarPubMed
11.Benson, PC, Swadron, SP.Empiric acyclovir is infrequently initiated in the emergency department to patients ultimately diagnosed with encephalitis. Ann Emerg Med. 2006;47:100–5.Google Scholar
12.Poissy, J, Wolff, M, Dewilde, A, et al.Factors associated with delay to acyclovir administration in 184 patients with herpes simplex virus encephalitis. Clin Microbiol Infect. 2009;15:560–4.Google Scholar
13.Bell, DJ, Suckling, R, Rothburn, MM, et al.Management of suspected herpes simplex virus encephalitis in adults in a U. K. teaching hospital. Clin Med. 2009;9:231–5.Google Scholar
14.Aronin, SI, Peduzzi, P, Quagliarello, VJ.Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med. 1998;129:862–9.Google Scholar
15.Gopal, AK, Whitehouse, JD, Simel, DL, Corey, GR.Cranial computed tomography before lumbar puncture: a prospective clinical evaluation. Arch Intern Med. 1999;159:2681–5.Google Scholar
16.Proulx, N, Frechette, D, Toye, B, Chan, J, Kravcik, S.Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. Quart J Med. 2005;98:291–8.Google Scholar
17.Auburtin, M, Wolff, M, Charpentier, J, et al.Detrimental role of delayed antibiotic administration and penicillin-nonsusceptible strains in adult intensive care unit patients with pneumococcal meningitis: the PNEUMOREA prospective multicenter study. Crit Care Med. 2006;34:2758–65.CrossRefGoogle ScholarPubMed