C6. CNS infection
Oral Abstract Submission
Herpes simplex virus (HSV) is the most common cause of infectious encephalitis in the United States. While early treatment with acyclovir has improved acute management, long-term morbidity and mortality remain high and warrant further characterization.
We retrospectively identified adult patients (≥18 years) with HSE admitted to the Cleveland Clinic Main Campus and affiliated regional hospitals from April 2006 to June 2016. HSE diagnosis was concordant with Infectious Disease Society of America Encephalitis Guidelines. HSE diagnosis was confirmed in that HSV-1 DNA was detected in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) assay for all patients included in this study. Patients for which HSV-2 was detected in the CSF were excluded to avoid inclusion of HSV meningitis. Clinical information was collected in a REDCap database and analyzed by descriptive statistics. Patients were indexed at date of admission, and Kaplan-Meier analysis was used to estimate overall survival.
Results : We identified 32 patients with confirmed HSE. The median patient age was 62 years (interquartile range [IQR] 45-72). All patients received treatment with intravenous (IV) acyclovir, with a median treatment duration of 24 days (IQR 19-30). The median time from initial symptom onset to IV acyclovir treatment was 5 days (IQR 3-8). Three patients (9%) died during the hospitalization course, 16 (50%) were discharged to a nursing facility, 11 (35%) returned home, and two (6%) transitioned to an acute care facility (Figure 1). Within three months of discharge, 15 (47%) patients were readmitted, six (19%) of which readmitted for HSE relapse. The overall survival rate at one month was 84% and 74% at 12 months (Figure 2). At outpatient follow-up, cognitive deficits were self-reported by 19 (66%) patients, followed in frequency by motor (31%) and sensory deficits (7%).
Conclusion : Despite appropriate treatment with IV acyclovir, HSE survivors frequently experienced severe morbidities after initial hospitalization, including HSE relapse, discharge to long-term care facilities, and neurocognitive impairment. Risk of death was highest within one month of admission. Further investigation is needed to optimize treatment of HSE to improve mortality and to reduce permanent neurologic deficits.