Management of suspected herpes simplex virus encephalitis in adults in a UK teaching hospital

• Published in: Clinical medicine (London, England) Vol. 9; no. 3; pp. 231 - 235
• Main Authors: Bell, David J, Suckling, Ruth, Rothburn, Michael M, Blanchard, Tom, Stoeter, David, Michael, Benedict, Cooke, Richard PD, Kneen, Rachel, Solomon, Tom
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01-06-2009; Royal College of Physicians
• Subjects: aciclovir; Acyclovir - therapeutic use; Adult; Aged; Aged, 80 and over; Antiviral Agents - therapeutic use; Biological and medical sciences; Brain - diagnostic imaging; central nervous system infection; DNA, Viral - cerebrospinal fluid; encephalitis; Encephalitis, Herpes Simplex - diagnosis; Encephalitis, Herpes Simplex - drug therapy; Female; General aspects; Herpes simplex virus; Hospitals, Teaching; Human viral diseases; Humans; Infectious diseases; lumbar puncture; Male; Medical sciences; Medication Errors - statistics & numerical data; Middle Aged; Original Papers; Polymerase Chain Reaction; Retrospective Studies; Spinal Puncture - statistics & numerical data; Time Factors; Tomography, X-Ray Computed; United Kingdom; Viral diseases; Viral diseases of the nervous system; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; United Kingdom; Europe; herpes simplex virus; lumbar puncture; encephalitis; central nervous system infection; aciclovir; Acyclic nucleoside; Purine nucleoside; Teaching hospital; Central nervous system; Viral encephalitis; Aciclovir; Nucleoside analog; Adult; Antiviral; Diagnosis; Hospital; Public health; DNA polymerase inhibitor; Human; Herpes; Hospitalization; Lumbar puncture; Infection; Medicine; Virus; Clinical management; Viral disease
• ISSN: 1470-2118; 1473-4893
• DOI: 10.7861/clinmedicine.9-3-231

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.