Abstract Details

Title Are We over Treating Herpes Simplex Virus Encephalitis?

Topic Infections/AIDS/Prion Disease

Presentation(s) S16 - (-)

Poster/Presentation
Number 005

Objective

Background HSV accounts for about 10% of all encephalitides cases in the US. HSV encephalitis is often treated prior to any confirmatory or supportive testing.

Design/Methods Retrospective chart review collected over 1 year period from Jan - Dec 2010 at the New Jersey Medical School Academic Centre. All patients treated with IV acyclovir were identified from pharmacy records. Those with genital or cutaneous herpes were excluded.

Results 123 patients were treated with IV acyclovir. Initial clinical presentations: Altered Mental Status 55 (44.7%); Fever 39 (31.7%); Headache 24 (19.5%); Seizure/syncope 12 (9.8%); Neck stiffness 8 (6.5%); Cough 4 (3.3%). Tests performed: Lumbar puncture in 80 (65%); CSF HSV PCR sent in 56 (45.5%); MRI brain in 54 (43.9 %); Electroencephalogram (EEG) in 28 (18.7%). Results: LP - 6 cases of xanthochromia, 32 cases of pleocytosis and only 3 cases of HSV by PCR; MRI - 2 cases showed increased signal in temporal lobes; EEG: 2 cases showed temporal sharps. HSV encephalitis confirmed by polymerase chain reaction (PCR) 3 (2.4%); Viral encephalitis "Not Otherwise Specified (NOS)" and Meningitis NOS 32 (26%); Sepsis 19 (15.4%); Toxic/metabolic encephalopathy 18 (14.6%); Bacterial/fungal meningitis 9 (7.3%); Cerebrovascular etiology 8 (6.5%); Seizure 5 (4%). Adverse effects: Acute renal failure 5 (4.1%), Transaminits 1 (0.8%).

Conclusions In our study group, only 3 cases (2.4%) treated with acyclovir had a definite diagnosis of HSV encephalitis. HSV encephalitis if often over treated resulting in increased Length of Stay (LOS) and unwarranted adverse effects. Average length of stay (LOS) was 5.8 days for every patient in our study population, driving up costs of health care. We recommend stronger clinical suspicion and aggressive work up prior to treatment initiation in patients with suspected HSV encephalitis.

Authors/Disclosures
Andy Rodriguez, MD (Institute of Neurology At Saint Barnabas) PRESENTER	No disclosure on file
Adithya Sivaraju, MD (Yale New Haven Medical Center)	Dr. Sivaraju has nothing to disclose.
Vineet Punia, MD (Cleveland Clinic)	Dr. Punia has nothing to disclose.
David A. Marks, MD	Dr. Marks has nothing to disclose.
Antonio M. Omuro, MD, FAAN (Stanford University)	Dr. Omuro has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ono Therapeutics. Dr. Omuro has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Telix. Dr. Omuro has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Curevac. The institution of Dr. Omuro has received research support from NIH. The institution of Dr. Omuro has received research support from Arcus Biosciences. The institution of Dr. Omuro has received research support from Denovo Biopharma. The institution of Dr. Omuro has received research support from Ono Pharmaceutical. The institution of Dr. Omuro has received research support from Servier. The institution of Dr. Omuro has received research support from Nanopharmaceuticals. The institution of Dr. Omuro has received research support from Denovo.

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