Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

Hakan Erdem, Yasemin Cag, Derya Ozturk-Engin, Sylviane Defres, Selcuk Kaya, Lykke Larsen, Mario Poljak, 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 Sipahi, Mahtab ChehriGuillaume Beraud, Ghaydaa Shehata, Rosa Fontana Del Vecchio, 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, Nevin Ince, Yasemin Akkoyunlu, Gulistan Halac, Elif Sahin-Horasan, Hulya Tireli, Gamze Kilicoglu, Akram Al-Mahdawi, Salih Atakan Nemli, Asuman Inan, Seniha Senbayrak, Jean Paul Stahl, Haluk Vahaboglu

Research output: Contribution to journalJournal articleResearchpeer-review

57 Citations (Scopus)


Data regarding factors predicting unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases is scarce in the literature. We conducted a multicenter study to provide insights into the predictors of outcome with special emphasis to use and timing of antivirals. Overall, 501 patients with molecular confirmation from the cerebrospinal fluid were included from 35 referral centers in 10 countries. Overall, 438 patients were found to be eligible for the analysis. Finally, 232 (52.9%) patients experienced unfavorable outcomes; 44 died and 188 survived with sequlae. Age (OR 1.04, 95% CIs 1.02-1.05), Glasgow coma scale (OR 0.84, 95% CIs 0.77-0.93), symptomatic period of 2-7 days (OR 1.80, 95% CIs 1.16-2.79) and over seven days (OR 3.75, 95% CIs 1.72-8.15) until treatment commenced, predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to favorable outcome.

Original languageEnglish
JournalAntimicrobial Agents and Chemotherapy
Issue number6
Pages (from-to)3084-3089
Number of pages6
Publication statusPublished - 2015


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