title: Herpes simplex encephalitis in Iceland 1987-2011.
abstract: Herpes simplex encephalitis (HSE) is a serious disease with 10-20% mortality and high rate of neuropsychiatric sequelae. This study is a long-term, nationwide study in a single country, Iceland. Clinical data were obtained from patient records and from DNA PCR and antibody assays of CSF. Diagnosis of HSE was classified as definite, possible or rejected based on symptoms, as well as virological, laboratory and brain imaging criteria. A total of 30 definite cases of HSE were identified during the 25 year period 1987-2011 corresponding to incidence of 4.3 cases/106 inhabitants/year. Males were 57% of all patients, median age 50 years (range, 0-85). Fever (97%), cognitive deficits (79%), impaired consciousness (79% with GCS < 13), headache (55%) and seizures (55%) were the most common symptoms. Brain lesions were found in 24 patients (80%) by MRI or CT. All patients received intravenous acyclovir for a mean duration of 20 days. Three patients (10%) died within one year and 21/28 pts (75%) had a Karnofsky performance score of <70% with memory loss (59%), dysphasia (44%), frontal symptoms (44%) and seizures (30%) as the most frequent sequelae. Mean delay from onset of symptoms to treatment was 6 days; this was associated with adverse outcome. In conclusion, the incidence of `HSE is higher than recently reported in a national registry study from Sweden. Despite advances in rapid diagnosis and availability of treatment of HSE, approximately three of every four patients die or are left with serious neurological impairment.
authors.affiliation: Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Heiður Mist
authors.initials: HM
authors.lastname: Dagsdóttir
authors.affiliation: Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland.
authors.forename: Bryndís
authors.initials: B
authors.lastname: Sigurðardóttir
authors.affiliation: Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland ; Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland.
authors.forename: Magnús
authors.initials: M
authors.lastname: Gottfreðsson
authors.affiliation: Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland.
authors.forename: Már
authors.initials: M
authors.lastname: Kristjánsson
authors.affiliation: Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland ; Department of Virology, Landspítali University Hospital, Reykjavik, Iceland.
authors.forename: Arthur
authors.initials: A
authors.lastname: Löve
authors.affiliation: Department of Virology, Landspítali University Hospital, Reykjavik, Iceland.
authors.forename: Guðrún Erna
authors.initials: GE
authors.lastname: Baldvinsdóttir
authors.affiliation: Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland ; Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland.
authors.forename: Sigurður
authors.initials: S
authors.lastname: Guðmundsson
keywords: Herpes simplex encephalitis; Herpes simplex virus; Neurological sequelae; Viral encephalitis