Herpes Simplex Virus Encephalitis With Initial Negative Polymerase Chain Reaction in the Cerebrospinal Fluid: Prevalence, Associated Factors, and Clinical Impact*. Issue 7 (3rd February 2022)

• Record Type: Journal Article
• Authors: de Montmollin, Etienne; Dupuis, Claire; Jaquet, Pierre; Sarton, Benjamine; Sazio, Charline; Susset, Vincent; Conrad, Marie; Argaud, Laurent; Demeret, Sophie; Tadié, Jean Marc; Barbier, François; Wolff, Michel; Timsit, Jean-François; Visseaux, Benoit; Sonneville, Romain
• Other Names: Marechal Julien author non-byline.; Mourvillier Bruno author non-byline.; Dailler Frederic author non-byline.; Bruneel Fabrice author non-byline.; Lautrette Alexandre author non-byline.; Novy Emmanuel author non-byline.; Guidet Bertrand author non-byline.; Mateos François author non-byline.; Brault Clément author non-byline.; Maestraggi Quentin author non-byline.; Razazi Keyvan author non-byline.; Quenot Jean-Pierre author non-byline.; Joret Aurélie author non-byline.; Levrat Albrice author non-byline.; Massri Alexandre author non-byline.; Robert Alexandre author non-byline.; Contou Damien author non-byline.; Mira Jean-Paul author non-byline.; Benghanem Sarah author non-byline.; Stephane Gaudry author non-byline.; Voiriot Guillaume author non-byline.; Berger Asael author non-byline.; Das Vincent author non-byline.; Engrand Nicolas author non-byline.; Murgier Martin author non-byline.; Siami Shidasp author non-byline.; Hraiech Sami author non-byline.; Mariotte Eric author non-byline.; Ragot Claire author non-byline.; Stoclin Annabelle author non-byline.; Trouiller Pierre author non-byline.; Schmidt Mathieu author non-byline.; Rohaut Benjamin author non-byline.; Franchineau Guillaume author non-byline.;
• Is Part Of: Critical care medicine. Volume 50:Issue 7(2022)
• Page Start: e643
• Page End: e648
• Publication Date: 2022-02-03
• Subjects: critical care -- diagnosis -- encephalitis -- herpes simplex virus -- polymerase chain reaction; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000005485
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : OBJECTIVES: To describe the prevalence, associated factors, and clinical impact of an initial negative herpes simplex virus (HSV) polymerase chain reaction (PCR) in critically ill patients with PCR-proven HSV encephalitis. DESIGN: Retrospective multicenter study from 2007 to 2017. SETTING: Forty-seven French ICUs. PATIENTS: Critically ill patients admitted to the ICU with possible/probable acute encephalitis and a positive cerebrospinal fluid (CSF) PCR for HSV. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 273 patients with a median Glasgow Coma Scale score of 9 (6–12) at ICU admission. CSF HSV PCR was negative in 11 cases (4%), exclusively in lumbar punctures (LPs) performed less than 4 days after symptoms onset. Patients with an initial negative PCR presented with more frequent focal neurologic signs (4/11 [36.4%] vs 35/256 [13.7%]; p = 0.04) and lower CSF leukocytosis (4 cells/mm 3 [3–25 cells/mm 3 ] vs 52 cells/mm 3 [12–160 cells/mm 3 ]; p < 0.01). An initial negative PCR was associated with an increased delay between LP and acyclovir treatment (3 d [2–7 ] vs 0 d [0–0 d]; p < 0.01) and was independently associated with a poor neurologic outcome at hospital discharge (modified Rankin Scale score ≥ 4) (adjusted odds ratio, 9.89; 95% CI, 1.18–82.78). CONCLUSIONS: In severe herpes simplex encephalitis, initial negative CSF HSV PCR occurred in 4% of cases and was independently associated with worse neurologic outcome at hospital discharge. In these patients, a systematic multimodal diagnostic approach including early brain MRI and EEG will help clinicians avoid delayed acyclovir initiation or early inappropriate discontinuation.