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首页> 外文期刊>Journal of clinical virology: The official publication of the Pan American Society for Clinical Virology >Herpes simplex virus encephalitis: Clinical manifestations, diagnosis and outcome in 106 adult patients
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Herpes simplex virus encephalitis: Clinical manifestations, diagnosis and outcome in 106 adult patients

机译：单纯疱疹病毒性脑炎：106例成人患者的临床表现，诊断和结果

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Background: Herpes simplex virus (HSV) is one of the most common causes of sporadic encephalitis worldwide. Objective: We aimed to determine clinical characteristics and prognosis of HSV encephalitis (HSVE) cases reviewed retrospectively from several collaborating centers. Study design: We searched hospital archives of the last 10 years for patients with HSVE diagnosis, i.e. clinical presentation compatible with encephalitis and brain involvement on magnetic resonance imaging (MRI) and/or detection of HSV DNA in the cerebrospinal fluid by polymerase chain reaction (PCR). Clinical characteristics were noted and patients were phone-interviewed. HSVE cases were grouped and analyzed as proven and probable, based on virological confirmation by PCR. Univariate and multivariate analyses were used to determine factors associated with prognosis. Results: A total of 106 patients (63 males and 43 females; mean age, 44 years; range, 18-83 years) were included. Most common symptoms were changes in mental status, fever, headache, and seizure. HSV PCR was positive in 69% of patients tested, while brain involvement was detected on MRI in 95%. Acyclovir was started mostly within five days of main symptom and continued for ≥14 days. Case fatality rate was 8%, while 69% of patients recovered with sequelae. Favorable prognosis was observed in 73% of patients. Multivariate analysis identified the duration of disease before hospital admission (odds ratio (OR) = 1.24) and the extent of brain involvement on MRI at the time of admission (OR = 37.22) as two independent risk factors associated with poor prognosis. Conclusions: Although HSVE fatality regressed considerably with acyclovir treatment, many patients survive with sequelae. Our results emphasize the importance of early diagnosis and prompt treatment of HSVE.
机译：背景：单纯疱疹病毒（HSV）是全世界散发性脑炎的最常见原因之一。目的：我们旨在确定从多个合作中心回顾性审查的HSV脑炎（HSVE）病例的临床特征和预后。研究设计：我们搜索了过去10年的医院档案，以寻找具有HSVE诊断的患者，即与脑炎和大脑受累的磁共振成像（MRI）和/或通过聚合酶链反应检测脑脊液中HSV DNA兼容的临床表现（ PCR）。记录临床特征，并对患者进行电话采访。根据PCR的病毒学证实，将HSVE病例分组并分析为经证实和可能。使用单因素和多因素分析来确定与预后相关的因素。结果：共纳入106例患者（男63例，女43例;平均年龄44岁;范围18-83岁）。最常见的症状是精神状态变化，发烧，头痛和癫痫发作。在测试的患者中，有69％的患者HSV PCR阳性，而在MRI中有95％的患者检测到大脑受累。阿昔洛韦主要在主要症状的五天内开始，并持续≥14天。病死率为8％，而69％的患者因后遗症康复。 73％的患者预后良好。多变量分析确定了入院前疾病的持续时间（比值比（OR）= 1.24）和入院时MRI上脑部受累程度（OR = 37.22）是与预后不良相关的两个独立危险因素。结论：尽管使用阿昔洛韦治疗可使HSVE死亡率大大降低，但仍有许多患者幸存后遗症。我们的结果强调了HSVE的早期诊断和及时治疗的重要性。

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