title: Management of suspected herpes simplex virus encephalitis in adults in a U.K. teaching hospital.
abstract: 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.
authors.affiliation: Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bell
authors.forename: Ruth
authors.initials: R
authors.lastname: Suckling
authors.forename: Michael M
authors.initials: MM
authors.lastname: Rothburn
authors.forename: Tom
authors.initials: T
authors.lastname: Blanchard
authors.forename: David
authors.initials: D
authors.lastname: Stoeter
authors.forename: Benedict
authors.initials: B
authors.lastname: Michael
authors.forename: Richard P D
authors.initials: RP
authors.lastname: Cooke
authors.forename: Rachel
authors.initials: R
authors.lastname: Kneen
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000706:statistics & numerical data; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D006113:United Kingdom
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir