Managing Atypical and Typical herpetic central nervous system infections: results of A Multinational study

Yasemin Cag, Hakan Erdem, Stephen Leib, Sylviane Defres, Selcuk Kaya, Lykke Larsen, Mario Poljak, Derya Ozturk-Engin, Bruno Barsic, Xavier Argemi, Signe Maj Sørensen, Anne Lisbeth Bohr, Pierre Tattevin, Jesper Damsgaard Gunst, Lenka Baštáková, Matjaž Jereb, Isik Somuncu Johansen, Oguz Karabay, Abdullah Umut Pekok, Oguz Resat SipahiMahtab Chehri, Guillaume Beraud, Ghaydaa Shehata, Rosa Fontana, Mauro Maresca, Hasan Karsen, Gonul Sengoz, Mustafa Sunbul, Gulden Yilmaz, Hava Yilmaz, Ahmad Sharif-Yakan, Souha Kanj, Emine Parlak, Filiz Pehlivanoglu, Fatime Korkmaz, Suheyla Komur, Sukran Kose, Mehmet Ulug, Sibel Bolukcu, Seher Ayten Coskuner, Jean Paul Stahl, Nevin Ince, Yasemin Akkoyunlu, Gulistan Halac, Elif Sahin-Horasan, Hulya Tireli, Gamze Kilicoglu, Akram Al-Mahdawi, Salih Atakan Nemli, Asuman Inan, Seniha Senbayrak, Haluk Vahaboglu, Nazif Elaldi

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26 Citations (Scopus)


There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focused on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV-DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the non-encephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the non-encephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3% and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3% and 87.5% of the cases with and without encephalitic clinical presentation, respectively. CSF HSV-PCR, EEG and MRI data should be collected for all patients with a central nervous system infection considering the subtle nature of HME.

Original languageEnglish
JournalClinical Microbiology and Infection
Issue number6
Pages (from-to)568.e9-568.e17
Number of pages9
Publication statusPublished - 2016


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