title: Elaboration of a clinical and paraclinical score to estimate the probability of herpes simplex virus encephalitis in patients with febrile, acute neurologic impairment.
abstract: Herpes simplex virus (HSV) encephalitis is associated with a high risk of mortality and sequelae, and early diagnosis and treatment in the emergency department are necessary. However, most patients present with non-specific febrile, acute neurologic impairment; this may lead clinicians to overlook the diagnosis of HSV encephalitis. We aimed to identify which data collected in the first hours in a medical setting were associated with the diagnosis of HSV encephalitis. We conducted a multicenter retrospective case-control study in four French public hospitals from 2007 to 2013. The cases were the adult patients who received a confirmed diagnosis of HSV encephalitis. The controls were all the patients who attended the emergency department of Grenoble hospital with a febrile acute neurologic impairment, without HSV detection by polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF), in 2012 and 2013. A multivariable logistic model was elaborated to estimate factors significantly associated with HSV encephalitis. Finally, an HSV probability score was derived from the logistic model. We identified 36 cases and 103 controls. Factors independently associated with HSV encephalitis were the absence of past neurological history (odds ratio [OR] 6.25 [95 % confidence interval (CI): 2.22-16.7]), the occurrence of seizure (OR 8.09 [95 % CI: 2.73-23.94]), a systolic blood pressure ≥140 mmHg (OR 5.11 [95 % CI: 1.77-14.77]), and a C-reactive protein <10 mg/L (OR 9.27 [95 % CI: 2.98-28.88]). An HSV probability score was calculated summing the value attributed to each independent factor. HSV encephalitis diagnosis may benefit from the use of this score based upon some easily accessible data. However, diagnostic evocation and probabilistic treatment must remain the rule.
authors.affiliation: Emergency Department, Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France. sfgennai@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Gennai
authors.affiliation: Emergency Department, Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France.
authors.forename: A
authors.initials: A
authors.lastname: Rallo
authors.affiliation: Emergency Department, Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France.
authors.forename: D
authors.initials: D
authors.lastname: Keil
authors.affiliation: Medical Evaluation Unit, Grenoble University Hospital, Grenoble, France.
authors.forename: A
authors.initials: A
authors.lastname: Seigneurin
authors.affiliation: Laboratory of Virology, Grenoble University Hospital, Grenoble, France.|Unit of Virus Host Cell Interactions (UVHCI), UMI 3265 UGA-EMBL-CNRS, Grenoble, France.|Grenoble Institute of Clinical, Biological and Epidemiological Infectiology, Faculty of Medicine, University Grenoble-Alpes, Grenoble, France.
authors.forename: R
authors.initials: R
authors.lastname: Germi
authors.affiliation: Unit of Virus Host Cell Interactions (UVHCI), UMI 3265 UGA-EMBL-CNRS, Grenoble, France. oepaulard@chu-grenoble.fr.|Grenoble Institute of Clinical, Biological and Epidemiological Infectiology, Faculty of Medicine, University Grenoble-Alpes, Grenoble, France. oepaulard@chu-grenoble.fr.|Infectious Diseases Department, Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France. oepaulard@chu-grenoble.fr.
authors.forename: O
authors.initials: O
authors.lastname: Epaulard
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers; D016022:Case-Control Studies; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000453:epidemiology*; D005602:France / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012720:Severity of Illness Index; D018139:Simplexvirus / Q000145:classification / Q000235:genetics
chemical_list: D015415:Biomarkers