Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Hakan Erdem; Yasemin Cag; Derya Ozturk-Engin; Sylviane Defres; Selcuk Kaya; Lykke Larsen; Mario Poljak; Bruno Barsic; Xavier Argemi; Signe Maj Sørensen; Anne Lisbeth Bohr; Pierre Tattevin; Jesper Damsgaard Gunst; Lenka Baštáková; Matjaž Jereb; Isik Somuncu Johansen; Oguz Karabay; Abdullah Umut Pekok; Oguz Resat Sipahi; Mahtab Chehri; Guillaume Beraud; Ghaydaa Shehata; Rosa Fontana Del Vecchio; Mauro Maresca; Hasan Karsen; Gonul Sengoz; Mustafa Sunbul; Gulden Yilmaz; Hava Yilmaz; Ahmad Sharif-Yakan; Souha Shararah Kanj; Emine Parlak; Filiz Pehlivanoglu; Fatime Korkmaz; Suheyla Komur; Sukran Kose; Mehmet Ulug; Sibel Bolukcu; Seher Ayten Coskuner; Nevin Ince; Yasemin Akkoyunlu; Gulistan Halac; Elif Sahin-Horasan; Hulya Tireli; Gamze Kilicoglu; Akram Al-Mahdawi; Salih Atakan Nemli; Asuman Inan; Seniha Senbayrak; Jean Paul Stahl; Haluk Vahaboglu

doi:10.1128/aac.05016-14

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Hakan Erdem, Yasemin Cag, Derya Ozturk-Engin, Sylviane Defres, Selcuk Kaya, Lykke Larsen, Mario Poljak, Bruno Barsic, Xavier Argemi, Signe Maj Sørensen, Anne Lisbeth Bohr, Pierre Tattevin, Jesper Damsgaard Gunst, Lenka Baštáková, Matjaž Jereb, Isik Somuncu Johansen, Oguz Karabay, Abdullah Umut Pekok, Oguz Resat Sipahi, Mahtab ChehriGuillaume Beraud, Ghaydaa Shehata, Rosa Fontana Del Vecchio, Mauro Maresca, Hasan Karsen, Gonul Sengoz, Mustafa Sunbul, Gulden Yilmaz, Hava Yilmaz, Ahmad Sharif-Yakan, Souha Shararah Kanj, Emine Parlak, Filiz Pehlivanoglu, Fatime Korkmaz, Suheyla Komur, Sukran Kose, Mehmet Ulug, Sibel Bolukcu, Seher Ayten Coskuner, Nevin Ince, Yasemin Akkoyunlu, Gulistan Halac, Elif Sahin-Horasan, Hulya Tireli, Gamze Kilicoglu, Akram Al-Mahdawi, Salih Atakan Nemli, Asuman Inan, Seniha Senbayrak, Jean Paul Stahl, Haluk Vahaboglu

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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.

Original language	English
Pages (from-to)	3084-3089
Number of pages	6
Journal	Antimicrobial Agents and Chemotherapy
Volume	59
Issue number	6
DOIs	https://doi.org/10.1128/aac.05016-14
Publication status	Published - 1 Jun 2015
Externally published	Yes

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10.1128/aac.05016-14

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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., ... Vahaboglu, H. (2015). Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis. Antimicrobial Agents and Chemotherapy, 59(6), 3084-3089. https://doi.org/10.1128/aac.05016-14

@article{48f27a65b1864df6a35d0c4ea3297211,

title = "Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis",

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.",

author = "Hakan Erdem and Yasemin Cag and Derya Ozturk-Engin and Sylviane Defres and Selcuk Kaya and Lykke Larsen and Mario Poljak and Bruno Barsic and Xavier Argemi and S{\o}rensen, \{Signe Maj\} and Bohr, \{Anne Lisbeth\} and Pierre Tattevin and Gunst, \{Jesper Damsgaard\} and Lenka Ba{\v s}t{\'a}kov{\'a} and Matja{\v z} Jereb and Johansen, \{Isik Somuncu\} and Oguz Karabay and Pekok, \{Abdullah Umut\} and Sipahi, \{Oguz Resat\} and Mahtab Chehri and Guillaume Beraud and Ghaydaa Shehata and \{Del Vecchio\}, \{Rosa Fontana\} and Mauro Maresca and Hasan Karsen and Gonul Sengoz and Mustafa Sunbul and Gulden Yilmaz and Hava Yilmaz and Ahmad Sharif-Yakan and Kanj, \{Souha Shararah\} and Emine Parlak and Filiz Pehlivanoglu and Fatime Korkmaz and Suheyla Komur and Sukran Kose and Mehmet Ulug and Sibel Bolukcu and Coskuner, \{Seher Ayten\} and Nevin Ince and Yasemin Akkoyunlu and Gulistan Halac and Elif Sahin-Horasan and Hulya Tireli and Gamze Kilicoglu and Akram Al-Mahdawi and Nemli, \{Salih Atakan\} and Asuman Inan and Seniha Senbayrak and Stahl, \{Jean Paul\} and Haluk Vahaboglu",

year = "2015",

month = jun,

day = "1",

doi = "10.1128/aac.05016-14",

language = "English",

volume = "59",

pages = "3084--3089",

journal = "Antimicrobial Agents and Chemotherapy",

issn = "0066-4804",

publisher = "American Society for Microbiology",

number = "6",

}

Erdem, H, Cag, Y, Ozturk-Engin, D, Defres, S, Kaya, S, Larsen, L, Poljak, M, Barsic, B, Argemi, X, Sørensen, SM, Bohr, AL, Tattevin, P, Gunst, JD, Baštáková, L, Jereb, M, Johansen, IS, Karabay, O, Pekok, AU, Sipahi, OR, Chehri, M, Beraud, G, Shehata, G, Del Vecchio, RF, Maresca, M, Karsen, H, Sengoz, G, Sunbul, M, Yilmaz, G, Yilmaz, H, Sharif-Yakan, A, Kanj, SS, Parlak, E, Pehlivanoglu, F, Korkmaz, F, Komur, S, Kose, S, Ulug, M, Bolukcu, S, Coskuner, SA, Ince, N, Akkoyunlu, Y, Halac, G, Sahin-Horasan, E, Tireli, H, Kilicoglu, G, Al-Mahdawi, A, Nemli, SA, Inan, A, Senbayrak, S, Stahl, JP & Vahaboglu, H 2015, 'Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis', Antimicrobial Agents and Chemotherapy, vol. 59, no. 6, pp. 3084-3089. https://doi.org/10.1128/aac.05016-14

TY - JOUR

T1 - Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

AU - Erdem, Hakan

AU - Cag, Yasemin

AU - Ozturk-Engin, Derya

AU - Defres, Sylviane

AU - Kaya, Selcuk

AU - Larsen, Lykke

AU - Poljak, Mario

AU - Barsic, Bruno

AU - Argemi, Xavier

AU - Sørensen, Signe Maj

AU - Bohr, Anne Lisbeth

AU - Tattevin, Pierre

AU - Gunst, Jesper Damsgaard

AU - Baštáková, Lenka

AU - Jereb, Matjaž

AU - Johansen, Isik Somuncu

AU - Karabay, Oguz

AU - Pekok, Abdullah Umut

AU - Sipahi, Oguz Resat

AU - Chehri, Mahtab

AU - Beraud, Guillaume

AU - Shehata, Ghaydaa

AU - Del Vecchio, Rosa Fontana

AU - Maresca, Mauro

AU - Karsen, Hasan

AU - Sengoz, Gonul

AU - Sunbul, Mustafa

AU - Yilmaz, Gulden

AU - Yilmaz, Hava

AU - Sharif-Yakan, Ahmad

AU - Kanj, Souha Shararah

AU - Parlak, Emine

AU - Pehlivanoglu, Filiz

AU - Korkmaz, Fatime

AU - Komur, Suheyla

AU - Kose, Sukran

AU - Ulug, Mehmet

AU - Bolukcu, Sibel

AU - Coskuner, Seher Ayten

AU - Ince, Nevin

AU - Akkoyunlu, Yasemin

AU - Halac, Gulistan

AU - Sahin-Horasan, Elif

AU - Tireli, Hulya

AU - Kilicoglu, Gamze

AU - Al-Mahdawi, Akram

AU - Nemli, Salih Atakan

AU - Inan, Asuman

AU - Senbayrak, Seniha

AU - Stahl, Jean Paul

AU - Vahaboglu, Haluk

PY - 2015/6/1

Y1 - 2015/6/1

N2 - 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.

AB - 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.

U2 - 10.1128/aac.05016-14

DO - 10.1128/aac.05016-14

M3 - Article

SN - 0066-4804

VL - 59

SP - 3084

EP - 3089

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

IS - 6

ER -

Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Abstract

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